Rural Community College Alliance presents:

Revitalizing Rural Economies
October 6-8, 2003 • San Antonio, Texas
CONFERENCE
REGISTRATION FORM
  
RCCA Member
Non RCCA
Early Bird registration, $145 per person
Payment must be received before Sept. 6
Early Bird registration, $175 per person
Payment must be received before Sept. 6
       
Regular registration, $165 per person
Payment received after Sept. 6
Regular registration, $200 per person
Payment received after Sept. 6
       
Group registration, $125 per person when three or more from same college/community attend--payment received before Sept. 6.
Please indicate number attending:
______________________________
Group registration, $150 per person when three or more from same college/community attend--payment received before Sept. 6.
Please indicate number attending:
______________________________
       

Group registration, $145 per person when three or more from same college/community attend--payment received after Sept. 6.
Please indicate number attending:
______________________________

 Group registration, $175 per person when three or more from same college/community attend--payment received after Sept. 6.
Please indicate number attending:
______________________________
       
TOTAL: ____________________________________ TOTAL: ____________________________________
     

For details about RCCA membership, click here.

Access the Exhibit Reservation Form
Please note: you must be registered for the conference in order to reserve an exhibit.

    

Name:_______________________________________________________________________________

Title:________________________________________________________________________________

Organization:_________________________________________________________________________

Address:______________________________________________________________________________

City/State/Zip:________________________________________________________________________

Phone:_______________________________________________________________________________

Fax:_________________________________________________________________________________

E-mail:_______________________________________________________________________________

Payment Information:
(please check):

________
Check
Make checks payable to:
IOWA STATE UNIVERSITY
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Purchase order
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 enclosed
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Money order
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 enclosed
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Credit Card (Visa or MasterCard only--see below)

Credit Card Type _________________________________________________________________

Credit Card Number _______________________________________________________________

Name of Card Holder ______________________________________________________________

Expiration Date ___________________________________________________________________

Signature ________________________________________________________________________

RETURN TO:
Pam Cooper
North Central Regional Center for Rural Development
Iowa State University
107 Curtiss Hall
Ames, IA 50011-1050
Phone: (515) 294-8321 Fax: (515) 294-3180
pkcooper@iastate.edu