Register by Credit Card

Use this form to pay by check or P.O.

Attendee Information

Name:

(to appear on your name tag)

Position Title:

(to appear on your name tag)

Institution:

Institution City:

Institution State:

Zip Code:

Country:

E-mail:

Note: Photos taken during the symposium (by Northwest personnel) may be used in Brick and Click publicity

Eating Options

Which would you prefer for lunch?
Regular Lunch Option Vegetarian Lunch Option

Attending the Pre-symposium dinner on October 31, 2013?
Yes No

Conference Registration Fees

Includes: Continental breakfast, lunch, snack break, a canvas tote bag and a copy of the symposium proceedings

Attendee ($135)
Presenter ($100)
Verified L.S. Graduate Student ($67.50)

I would like additional copies of this year's proceedings. ($20 per copy)

Total Amount Due: $

Registrations made after October 11, 2013 will not be included in the list of attendees and may not include lunch or symposium proceedings.

We intend to distribute our list of attendees to all conference participants. Do you want your contact information listed?
Yes No

Cardholder Information

First Name:

Last Name:

Address:

City:

State:

Zip:

Country:

Phone:

Email: