Instructional Technology and Education of the Deaf

Supporting Learners, K — College
An International Symposium

June 25-27, 2001 ~ Symposium
June 28-29, 2001 ~ Workshops
National Technical Institute for the Deaf
Rochester Institute of Technology
Rochester, NY

http://www.rit.edu/ntid/vp/techsym/

 

Symposium Registration Form

Please copy and mail or fax this completed form to:

E. William Clymer, Symposium Coordinator, NTID/RIT, 52 Lomb Memorial Drive, Rochester, NY 14623-5604
Name (Last, First, MI) Position/Title
[] K-12 [] Postsecondary [] Teaching Faculty [] Administration [] Technical Support
Institutional Affiliation Phone
Voice
TTY 		Email

Fax
Address
City State Zip/Postal Code Country

Interpreter and Other Special Needs To ensure your requests are fulfilled, registration must be received by June 1, 2001.

Efforts are being made to serve the needs of a diverse group of registrants. The following services will be provided as resources allow. Please check those services that you intend to use if available:

[] Sign Language Interpreter
[] Infrared ALD receiver (available with headset and neck loop)
[] Induction Loop receiver (Panara Theater only)
[] Other special Needs (Please list):

Registration Worksheet
Symposium Registration

Early
(Before 5/11/01)

Regular Fee

Student

Amount
 

$100

$125

$50

$
Workshops        
Thursday        
Workshop Code for your Choices        
____1st ____2nd ____3rd $100 $125 - $
Friday        
Workshop Code for your Choices        
____1st ____2nd ____3rd

$100

$125

-

$
   

Total

Registration

$

Method of Payment

Three Easy Ways to Register

  • Fax: Complete the "Symposium Registration Form", include your credit card information and fax to 716-475-7588.

  • Mail: Complete the "Symposium Registration Form", include your check or credit card information and mail to the Symposium Office

  • Phone: Complete the "Symposium Registration Form", with your credit card ready, call the Symposium Office at 716-475-6704. A copy of your registration form will be mailed to you.

Registration fees can be paid by check or credit card. Make checks payable to Rochester Institute of Technology. To qualify for the Early Registration fees, your registration materials must be received by May 11, 2001.

 

Check Enclosed for $_______________

Charge to my (please circle): MASTERCARDVISA

Card#___________________________________________ Expiration Date____________

Name on Card _________________________________

Authorized Signature____________________________________

 

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