Western Illinois University: Macomb Campus
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Dealing with Difference Institute
2013 DEALING WITH DIFFERENCE INSTITUTE
Tuesday, May 14 & Wednesday, May 15
REGISTRATION FORM FOR WIU FACULTY, STAFF, & STUDENTS
Title & Department/Office: ________________________________________________________
Phone: __________________________________ Email: _________________________________
Registration Fee Waiver
The registration fee for WIU personnel is waived though registration is required to facilitate institute planning.
______ I plan to attend the DWDI on both Tuesday, May 14, and Wednesday, May 15.
______ I plan to attend the DWDI on Tuesday, May 14.
______ I plan to attend the DWDI on Wednesday, May 15.
We encourage you to have your meals with the other institute participants since doing so provides a valuable opportunity to exchange ideas and to carry on the discussions initiated during the sessions.
The WIU Expanding Cultural Diversity Project will cover the cost of meals for WIU participants, except the cost of the May 14 dinner. Please indicate the meals for which you want a reservation.
_____ $15 Dinner, Tuesday, May 14, 6:15 p.m. Alumni House. I have enclosed a check made out to WIU-DWDI to cover the cost of this meal.
_____ Wednesday, May 15 Lunch
_____ I prefer vegetarian meals.
If you need special accommodations or have questions about the institute, please contact Janice Welsch (firstname.lastname@example.org / 309-298-2057) or J.Q. Adams (email@example.com / 309-298-3698).
The DWDI schedule and information about the program and course credit options are posted at
Total Amount Enclosed (Tuesday Meal) $ __________
Please return this completed registration form (with a check if appropriate) by Tuesday, May 7, 2012 to ECDP/Simpkins 207, WIU, 1 University Circle, Macomb, IL 61455
(No one will be turned away if they have not pre-registered, but having a close-to-accurate count of participants will definitely help with planning. Thanks.)