International Consortium for Educational and Economic Development

Registration Form/ Forma de Registro

* Indicates required fields

* Name/Nombre:

Title/Cargo :

* Institution/Institución:

* Full Address/Domicilio Completo :

* Telephone/Teléfono (Include Area Code/ Incluya Claves de Lada):

(ddd-ddd-dddd)

Fax:

(ddd-ddd-dddd)

*Email:

(Must conform to the correct email format)

Are you Bringing a Companion? /
¿Traerá usted acompañante?

Yes/Sí No

Name of companion/
Nombre de su acompañante :

In what language is your companion fluent? /¿Cuál es el idioma de su acompañante?

English/Inglés
Spanish/Español

Registration Fee / Costo de Registro:

Please complete one registration per person / Favor de completar una planilla por persona.

(NOTE: Additional member of your institution must complete a separate registration. They are not considered as companions. Personas adicionales de su institucion deben de llenar un registro, no son considerados como acompañantes)

	By Mar. 11, 2010	After Mar. 11, 2010
Mexican Member/ Miembro Mexicano	350 $ US	400 $ US
Canadian Member/ Miembro Canadiense	350 $ US	400 $ US
U.S. Member/ Miembro de USA	350 $ US	400 $ US
Non Members *	650 $ US	700 $ US
Companion Rate	100 $ US	Not available
* if non member joins ICEED, difference will be returned or applied to the next conference.

Total Amount Due
/ Cantidad Total a Pagar:

$ (Must be numeric)

PAYMENT METHOD
Please check one.

CREDIT CARD
To pay by credit card printed and fax the conference registration form below to (714) 796-3921. We only accept Visa, MasterCard and Discover.

Download Conference Registration Form

CHECK
Make checks payable to ICEED and mail to the address below. US Dollars Only.

AT DOOR
All payments made at door must be in the form of cashier’s check, traveler’s check and money order. US Dollars Only.

MAILING ADDRESS:

Rancho Santiago Community College District / ICEED
2323 North Broadway, Suite 201
Santa Ana, CA 92706

Telephone: (714) 564-5414
Fax: (714) 796-3921
Email: valadez_jacqueline@rsccd.edu