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International Alliance of Teacher Scholars

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Institute & Conference Registration Form

Sorry, the 2008 FLC Institute is full. If you would like to be placed on the waiting list, please send your full contact information to alliance@iats.com. We will notify you if space becomes available.

There is still space for participation in the Faculty Learning Community Conference on June 21st. The form for registering is below. The FLC Conference program will be available in early June.

Below you will find the form to register for the FLC Conference. Please be sure to fill out all items in the form. Should you have any questions, please feel free to contact us at alliance@iats.com.  You may print this form out and send by mail, fax, or submit online today!
Registration:
First Name:
Middle Initial:
Last Name:
First Name or Nickname (for name tag)
  
Gender: Male  Female
Unit/Department:
Institution/Organization:
Mailing Address:
City:
State/Prov.:
ZIP/Postal Code:
Country
Work Telephone: ()
Work FAX: ()
Home Telephone: ()
Cellular Telephone: ()
Email:
 
Special Meal Requirements (Select all that apply.).
 
Meals:
No Beef No Poultry No Fish
No Pork No Dairy Products No Eggs
Registration Type:
Other Team Members:
 
 Payment Information.  IATS’ Federal ID Number is 25-1741294
 
Payment Enclosed: Select this box if you will print out this form and send your registration by mail.
Charge my account:
Account Number:
Expiration Date:
Billing Address:
Zip Code:
Signature:
(required if you are printing this out and sending it by mail or faxing in your registration.)		 _________________________________________________

 

Once you have filled out all the above information, you may register for the FLC Institute one of three ways:

1) Print out this form and send it and the appropriate payment to: 

International Alliance of Teacher Scholars
Box 1000
Claremont, CA 91711, USA 

2) If you are paying by credit card, you may print out this form and fax it to 909.621.8270.  Please be sure to sign the form before you fax it to us.

3) You may submit this form online by clicking on the submit button below.  Your account will be charged the appropriate fee. 

Thank you for your participation and we look forward to seeing you soon!