Event Registration Form

  Developmental Math Institute Student
Success		 Teaching Institute Facilitator's Institute
Dates January 23-25, 2008 May 19-21, 2008 August 13-15, 2008 October 1-3, 2008

Fee including registration, institute materials, and continental breakfasts and lunches.

$550/person $550/person $550/person $550/person

Multiple-person discount:  Fee applies when teams of three or more from the same institution attend an institute.

 $450/person $450/person $450/person $450/person

Fee including registration, institute materials, and overnight accommodations at Eagle Ridge Conference Center, continental breakfasts and lunches.

 $775/person $775/person $775/person $775/person
HCC Eagle Ridge Conference Center Contact Peggy Lofton 601-857-7100 pdlofton@hindscc.edu
Hinds Community College Contact  Jane L. Flowers 601-629-6850 jlflowers@hindscc.edu
 
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For multiple person or group registration, enter a contact person or group representative in the fields at left and the remaining names below:
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  Developmental Math Student Success Teaching Institute Facilitator's Institute
  January 23-25, 2008 May 19-21, 2008 August 13-15, 2008 October 1-3, 2008
 
* Method of Payment:
     Please bill me. Use the following Purchase Order number:
     A check made payable to "Hinds Community College" is being sent to:

Hinds Community College
Attn: Peggy Lofton
PO Box 1100
Raymond, Mississippi 39154-1100
 
     I am registering as a participant from the host school. My registration is being paid by my institution.
 
* Payment Amount:

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