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BPD CONFERENCE REGISTRATION FORM
19TH ANNUAL BPD CONFERENCE - OCTOBER 31 - NOVEMBER 4, 2001
DENVER, COLORADO
(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
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