Registration Form 2011

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					                                                   February 2-4, 2011

                                          Conference Registration Form
First Name:       Preferred First Name (for badge):                    Last Name:
Title:      Organization:
Mailing Address:       City:           State:                   Zip:
Day Phone:        Fax:         E-mail:

Select the appropriate conference fee(s):
Registration                               $415
Group Registration*                        $345
  (3 or more registrants from same organization)
Presenter Registration                     $215

* If 3 registrants are not received from organization by January 4, 2011, registrants will be charged full conference registration
rate.

Payment Method
   Check (made payable to Ferris State University)
   Invoice
   Purchase Order – Number:
   Credit Card (check one):        Visa            Mastercard
       Cardholder’s Name (as it appears on card):
       Credit Card Number:            Expiration Date:

         Signature: ______________________________________________

Send completed form with payment (if applicable) to:
                                       2011 Alternatives Conference
                                       Ferris State University
                                       410 Oak St., Alumni 113
                                       Big Rapids, MI 49307
                                       Fax: (231)591-3539

Refunds/Cancellations:
All requests for refunds or cancellations received in writing by January 5, 2011 will be honored, minus a $50
administrative fee. Cancellations received after January 5, 2011 will not be refunded. After that date, registration
may be transferred to another person only.

Questions? Call the Ferris State University Conference Services Office at (800)562-9130 or e-mail them at
caps@ferris.edu.

				
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