Illinois Association for Cultural Diversity

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16th Annual Dealing with Difference Institute
Tuesday and Wednesday, May 19-20, 2009
Spoon River College, Macomb, IL

Registration Form

Download PDF Forms: Off-campus / WIU Faculty/Staff/Students

Name:
Title/Department/Office:
Institution:
Address:
City/State/Zip code:
Day Phone (include area code) :
E-Mail Address:

Institute Fees

$30 Registration received by May 12, 2009 (includes Institute materials)
$35 Registration received after May 12, 2009 (includes Institute materials)
$10 Student Registration received by May 12, 2009 (includes Institute materials)
$15 Student Registration after May 12, 2009 (includes Institute materials)

Meals*

$55.00 All Meals & Refreshment Breaks
OR
$33.00 Lunch, Dinner, and Refreshment Breaks - Tuesday, May 19
$22.00 Continental Breakfast Buffet, Lunch, Breaks - Wednesday, May 20

I prefer vegetarian meals.

*We encourage you to have your meals with Institute participants since doing so provides a valuable opportunity to exchange ideas and to carry on the discussions initiated during the sessions.

If you need special accommodations, please contact us so we may assist you.

Total Amount Enclosed (Registration + Meals) $
Please return the completed registration form with a check for the appropriate amount payable to IACD-DWDI.

Mail to:

IACD/Simpkins 207
Western Illinois University
1 University Circle
Macomb, IL 61455-1390

For further information: e-mail Dr. J.Q. Adams or Dr. Janice Welsch with any questions about the institute.