REGISTRATION FORM

2010 Institute on Social Justice

“Beyond the Typical”
November 7 – 10, 2010 • Chicago, Illinois USA

Campus Host: Loyola University Chicago

Three Easy Ways to Register: Register online 24 hours a day!

www.myacpa.org/pd/socialjustice. Mail to: ACPA, One Dupont Circle, Suite 300,
Washington, DC, 20036 or fax to 202.296.3286

ACPA Membership #: _____________

Name & Title

E-mail Address

Institution

Mailing Address

City, State, Zip

Telephone Fax

______ Please check here if you have special needs (e.g. accessibility services, dietary
restrictions, etc.)
(Specify need: ________________________________________)

Early Bird Registration – Deadline date October 7, 2010

ACPA Individual Member $395 Nonmember $494 Student $175

Regular Registration – After October 7, 2010

ACPA Individual Member $475 Nonmember $625 Student $250

Payment Method

___Check ____Money Order ___Credit Card

Circle type: Visa Mastercard American Express ___Discover

Credit Card Number

Expiration Date

Name on Card (Please Print)

Cardholder Signature
____________________________________________
Total Registration: $

Payment and Cancellation Policy

Registrations can be paid by check, VISA, MasterCard, or American Express. All fees
must be prepaid. Purchase orders are not accepted. Refunds will be given for
cancellations, received in writing at ACPA by October 20, 2010 less a $50 processing
fee. After October 20, there are no refunds. ACPA reserves the right to charge a
service fee of $20 for returned checks. A processing fee of $20 per registration will be
charged for credit cards declined or to change payment methods after the initial
payment is processed. Registrations are non-transferable. The conference may be
cancelled or postponed due to insufficient enrollment or other unforeseen
circumstances. In this case, the fees will be fully refunded; however, ACPA will not be
responsible for other additional costs, charges or expenses, including
cancellation/change charges accessed by airlines and/or travel agencies.

Questions? Call Vernon A. Wall at 202.835.2272 or email vwall@acpa.nche.edu.