20 Years of Presenting the Scholarship of Teaching and Learning

International Alliance of Teacher Scholars

 Home  Contact Us  News
Conferences  Publications  Membership


2008 Lilly-West Registration Form
Below you will find the form to register for Lilly-West 2008.  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!

 
First Name:
Middle Initial:
Last Name:
First Name or Nickname (for name tag)
  
Are you submitting a proposal for presentation? Yes  No
 
Gender: Male Female
Unit/Department:
Institution/Organization:
Mailing Address:
City:
State/Prov.:
ZIP/Postal Code:
Country
Work Telephone: ()
Work FAX: ()
Home Telephone: ()
Email:
 
Special Requirements (Select all that apply.).
 
Meals:
No Beef No Poultry No Fish
No Pork No Dairy Products No Eggs
Other: Sign Interpreter
Wheelchair Access
Other:
 
Check with your Faculty Development Office or Academic VP’s office to see whether your institution is a cosponsor and/or is sending a team which would qualify you for a discounted registration rate. Teams must submit forms & payment together.

Conference Fees.
Please select from the following conference packages:
 
 
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 Lilly-West one of three ways:

1) If you are paying by credit card, you may submit this form online by clicking on the submit button below. Your account will be charged the appropriate fee. Unavailable for cosponsor registration.

3) 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. Unavailable for cosponsor registration.

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

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

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