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BPD Update Online, Spring 2001
Conference Registration

Conference Registration Form - Under Construction

(Please TYPE or PRINT)

Last Name: _______________________________ First Name: _______________________________________

University/College/Affiliation: ___________________________________________________________________

Address: _____________________________________________________________________________________

City/State/Zip Code: ___________________________________________________________________________

Phone (Office): (___)__________________________ (Home): (___)______________________________

Fax: (___)____________________________ Email: ___________________________________

(Optional) Emergency Contact: _______________________________________ Phone: (__)_________________________

The full conference registration includes the reception on Wednesday, October 31, the Recognition Luncheon on Friday, November 3, and the Banquet on Saturday, November 4. Payment (personal or university checks or credit card information) must accompany the registration form. BPD is unable to accept purchase orders. Forms received without full payment will be returned. Early bird registration must be postmarked by September 15, 2001. In order to register at the member rate, your membership for the 2001-year should be paid 30 days prior to the conference, or registration can be sent with membership form. All identified presenters and conveners must be registered for the conference and be members of BPD. To avoid cancellation of presentations, presenters' registration must be received by the early bird registration deadline. Cancellation of registration and/or memberships and requests for refunds must be in writing and received by the Conference Registrar by October 1, 2001. There is a $25 handling fee for all conference refunds. Undergraduate BSW student volunteers are provided free conference registration for working six hours at the conference; however this does not include the Luncheon and the Banquet. The cost of the meal functions is $35.

Registration Early Bird Registration Late Registration
(Postmarked by Sept. 15th) (Postmarked after Sept. 15th)
Select One Member Nonmember Member Nonmember Total
Full Conference - OR - $205.00 $340.00 $235.00 $370.00

Circle Day: Wed. Thurs. Fri. Sat.One Day w/o reception/banquet $105.00 $240.00 $135.00 $270.00
Circle Day: Wednesday Friday Saturday One Day with reception/lunch/banquet $140.00 $275.00 $170.00 $305.00
Luncheon for BSW Program DirectorsWednesday, October 31, 2001 $15.00 $15.00 $15.00 $15.00

______Please check if you wish a vegetarian meal.

Undergraduate BSW Student Rate: Without meals: _____ $75.00 With Meals: ____ $140.00

Curriculum Materials and Sessions on disk (additional $35) $____________

Additional Meal Tickets:
___Additional Reception Tickets @ $35.00 _____No. of Tickets $____________
(Wednesday, October 31, 2001)
___Additional Luncheon Tickets @ $35.00 _____No. of Tickets $____________
(Friday, November 2, 2001)
___Additional Banquet Tickets @ $35.00 _____No. of Tickets $____________
(Saturday, November 3, 2001)

Conference Registration Amount Total $____________

Continued on Back F

Membership Number: ___________

Membership Status: ___Full ___Associate ___Emeritus

Position: ___Program Director ___ Faculty ___Field Director
___BSW Student ___Other: _________________________________

New Attendee: ___First Time Attendee ____Second Time Attendee

____Check if you require special services related to a disabling condition. (Please attach a detailed written description of your needs and mail with this registration form.)

BPD Fein #55-0563314

If paying by credit card, please complete the following:
Credit card: ___Visa __MasterCard __AMEX Card number:________________________________________ Expiration: ___/___

Please make check payable to: BPD Conference

Please mail to:
KRA Corporation
1010 Wayne Avenue
Suite 800
Silver Spring, MD 20910
Attention: BPD Conference Registration

You may also register online at www.bpdonline.org

For inquiries, contact:

Elijah Mickel, BPD Registrar
Delaware State University
1200 North DuPont Highway
Dover, DE 19901
Phone: (302) 857-6771
Fax: (302) 857-6794
E-mail: emickel@dsc.edu

The BPD Update Online Web Site is sponsored by Lyceum Books.