Midwest Interlibrary Loan Conference Registration
 

Default Section

 

1. First Name

2. Last Name

3. Institution:

4. Institution City:

5. Institution State:

6. I am from:

7. E-mail address:

8. OCLC Code

9. I plan to attend the dinner, Thursday April 12, 2012 (Casual dinner, at your own expense)

10. Conference Registration fees (includes continental breakfast, lunch, and snacks.)
Lunch will be a Boxed Lunch - more details will be forthcoming.

Please click "Yes, Please" if you want a vegetarian lunch - thanks!

11. $60.00 Attendee

12. $45.00 Presenter

13. $30.00 Library Science Student

14. Total Amount enclosed:

Registration after March 23, 2012 will be $70. Late registrants may not be able to attend the dinner on April 12, 2012.

15. I do NOT want my contact information included in conference handouts.

Please make your check payable to: DALINC. We will also accept credit cards or purchase orders. Use the PayPal link on the Registration web page to pay by credit card.

16. I paid by:

If paying by check or purchase order, mail funds and registration form to:
Susan Ebertz
PO Box 5004
333 Wartburg Place
Dubuque, IA 52004

Or you may fax your PO and registration form to 563-588-7292. Upon receipt of registration and payment a confirmation e-mail will be sent to you.

Thank you!