Chairing the Academic Department

2009-10 Registration Form

Please print this page and mail or fax to the address below.  Also, please indicate which workshop you wish to attend:

November 4-7, 2009 Austin, TX Omni Austin Hotel Downtown	February 24-27, 2010 San Diego, CA Catamaran Resort Hotel	June 16-19, 2010 Washington, DC/Arlington, VA The Westin Arlington Gateway

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

Length of time serving as chair:		______				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:
	ACE Member Institutions*	Non-member Institutions
	$925 first registrant $900 each additional registrant	$1,025 first registrant $1,000 each additional registrant
How many registrants are there from your institution? ______
Fees include materials, refreshment breaks, one dinner, three 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 must be received by fax or email. Cancellation notices received at ACE three weeks before the
scheduled Workshop will receive a full refund less a $100 administrative fee. Cancellations received between three weeks
and one week 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 06/23/2009