Advanced Workshop from ACE!

Leading, Managing, Supporting, and Navigating Change Workshop

July 15–17, 2009

Registration Form

Please print this page and mail or fax to the address below.

Badge and Address Information: (Please furnish for each participant)
Name:	_______________________________________________________________
Title:	_______________________________________________________________
Phone:	_____________	Fax:	______________		E-mail:	__________________
Department:	_______________________________________________________________
Institution:	_______________________________________________________________
Address:	_______________________________________________________________
City:	_____________	State:	________	Zip:	_______________
Gender:	Male Female
Previous ACE/Other Workshop Experience:	_______________________________________________________________
	_______________________________________________________________

Length of time in current position:		______				Length of time at institution:	______
Number of faculty in department:		Full-time:	______	Part-time:	______
Department enrollment:		Undergraduate:	______	Graduate:	______
Name of dean/provost:		_____________________________________________
Institution Type:		Public	Private
please check		Community College		Research Institution			HBCU
all that apply		Proprietary		Federal			Minority-serving
		Undergraduate only		Undergrad/Graduate

Registration Fees:
EARLY BIRD (UNTIL Wednesday, April 15, 2009)
ACE Member Institutions*	Non-Member Institutions
$1,050 first registrant  $1,000 each additional registrant	$1,150 first registrant  $1,100 each additional registrant
REGULAR FEE (AFTER Wednesday, April 15, 2009)
ACE Member Institutions*	Non-Member Institutions
$1,150 first registrant  $1,100 each additional registrant	$1,250 first registrant  $1,200 each additional registrant
How many registrants are there from your institution? ______
Fees include materials, refreshment breaks, two dinners, two continental breakfasts, and two luncheons.
*Please verify your institution's membership in ACE by calling your president's office or checking ACE's Online Membership Directory.

Payment Type:
Check Enclosed$____________		Purchase Order Number#____________________________
Credit Card	MasterCard	Visa	American Express
Card Number	#_____________________________________________
Name on Card	_____________________________________________
Expiration Date:	___________________

Payment or a purchase order should accompany your registration. If institutional policy does not permit prepayment, written evidence of a payment plan must be provided. All registrations, even if not accompanied by payment, are liable for late cancellation fees and will be billed as per the cancellation and refund policy.

Cancellation notices will only be accepted by fax or email. Cancellation notices received at ACE three weeks before the scheduled July Workshop (June 19, 2009) will receive a full refund less a $100 administrative fee. Cancellations received between three weeks and one week (June 22-July 7) prior to the scheduled workshop will be refunded 50%. After this time, there will be no refunds.

Registration form(s) may be faxed to (202) 833-5696 or mailed with checks to: American Council on Education, Department Leadership Program, Department 36, Washington, DC 20055-0036.

Please direct questions about this page to:
brinda_albert@ace.nche.edu
This page last updated 03/19/2009