PKC 2003 Registration

January 6-8, 2003 - Miami, Florida, USA

Instructions:

To register for PKC 2003, you may FAX or post this completed form with payment to:

PKC 2003 Conference Registrar

Center for Professional Development, Florida State University

Tallahassee, FL 32306, USA
FAX number: 1+ (850) 644-3803 with credit card payment information. We cannot accept registrations by email.

---

Personal Information

Name:______________________________________________________________________________________________

Affiliation:___________________________________________________________________________________________

Address:____________________________________________________________________________________________

_____________________________________________________________________________________________

Phone:______________________________________________________ FAX:____________________________________

Email:________________________________________________________________________________________________

---

Conference Registration

a.	Full Time Student	$240	[     ]
b.	Regular Registration Fee	$580	[     ]
c.	Extra Copy of Proceedings	$ 60	[     ]

Paper Charges (For Accepted Authors): Select the appropriate amount –

No more than14pgs, no charge; 15pgs, $90 [ ]; 16pgs, $160 [ ]; 17pgs, $250 [ ]; 18pgs $320 [  ].

IF YOUR REGISTRATION IS POSTED AFTER December 1st, 2002 - ADD $100 [     ]

TOTAL AMOUNT DUE (US Dollars only): $_______________

Payment - We accept checks IN US DOLLARS DRAWN ON A US BANK made payable to Florida State University, or credit cards. You MUST include your payment in full when you return this form. If you choose to pay by credit card, complete the following.

Card Type:	Visa [      ]        MasterCard [      ] Discover [      ] American Express [      ]
Card Number:
Expiration Date:	______________________________________________________________
Name on Card:	______________________________________________________________
Cardholder’s signature:	______________________________________________________________

---

Personal Information: The personal contact information that you provide will be published in the conference attendee list. It is NOT made available to any other organization in electronic form. If you do NOT want your contact information to be published in the conference attendee list, choose this box: I DO NOT WANT MY DETAILS PUBLISHED [      ]

---

Cancellation Policy: Cancellations received by December 1st will be considered for a refund less a cancellation charge of $100, and $60 to cover a copy of the conference proceedings. No refunds will be made for cancellations received after December 1st. A copy of the proceedings will be mailed to all those who registered but did not attend.

---

You can also register online at learningforlife.fsu.edu.