ࡱ> WYV#` %bjbj5G5G {:W-W-|||||||$PTl<P  eD$hE"BE|" ||+GX|||| [! P]0"""|00"hXD  ||||||  21st Annual TACCLD Conference Extending The Bridge Registration and Membership Form (Please click mouse in the text field to enter text then tab to next field. Click appropriate check boxes to make selections. Print and mail to address below) Name:  FORMTEXT       Title:  FORMTEXT       School / Institution:  FORMTEXT       Business Address:  FORMTEXT        FORMTEXT       City:  FORMTEXT       State:  FORMTEXT       Zip:  FORMTEXT       Phone:  FORMTEXT       E-Mail Address:  FORMTEXT       Please indicate if any of the following apply:  FORMCHECKBOX  I am interested in being a concurrent session moderator for the conference.  FORMCHECKBOX  Special needs associated with my disability include  FORMTEXT      .  FORMCHECKBOX  I need a vegetarian lunch.  FORMCHECKBOX  I will be staying overnight at the Blackwell*. *(Please note that this information is for planning committee purposes only; it will not  !"678XYZ[ Ƚȯ攄zm`z`z`UMDhhaJhCJaJhvPhvPOJQJhvPhvPCJOJQJhvPhnCJOJQJhnCJOJQJhh5>*CJ OJQJh5>*CJ OJQJh= hh= h5CJ OJQJh= hh5CJ OJQJh]5CJ OJQJhh5CJ OJQJh= hh= h5CJ H*OJQJh= h5CJ OJQJhh5CJOJQJ8YX Z B fhR V \ gd gdvP gd $ a$gd $ a$gd%%     " , . 0 2 F H J T V X Z f ؚⓊxⓊf"j\hhu>*UaJ"jhhu>*UaJhhnaJ h>*aJ"jthhu>*UaJ hnaJ'jhh>*UaJmHnHu"jhhu>*UaJhh>*aJjhh>*UaJhhaJ haJ(    0 2 4 > @ B L N P R f h j t v ֢uc"jhhu>*UaJ"jFhhu>*UaJhh>*aJ!jh>*UaJmHnHu"jhhu>*UaJjh>*UaJ haJhhaJ hn>*aJ h>*aJ'jhh>*UaJmHnHujhh>*UaJ&       ( * . > J \ ^ ` t v x Ļߢ߲ߢ~߲sh^ShhCJ aJhh6aJhhCJaJhhCJaJ"jhhu>*UaJ"jhhu>*UaJhh>*aJ haJhhaJhhnaJ h>*aJ'jhh>*UaJmHnHujhh>*UaJ"j.hhu>*UaJ   l n *,<>RTV`bfhj봫ۂ۴vo]vLv!jh>*UaJmHnHu"jrhhu>*UaJ h>*aJjh>*UaJ.jhk_hD5CJOJQJUaJhhCJ aJ haJhhaJhhCJOJQJaJ.jhvPhD5CJOJQJUaJhvPh5CJOJQJaJ(jhvPh5CJOJQJUaJDFLNP N P R T V Z ôÈôwuodUJh]hO@CJaJjhhCJ0UaJhOhCJaJ hO@aJUhnhCJ aJ hnaJ.j\hvPhD5CJOJQJUaJhhCJ aJhhaJhhCJOJQJaJhvPh5CJOJQJaJ(jhvPh5CJOJQJUaJ.jhvPhD5CJOJQJUaJserve as a reservation with the hotel.)  Conference Fees: If Received Prior to January 26, 2008$90If Received After January 26, 2008$100Students$50Membership only, (not attending conference)$10Total Amount Enclosed$ FORMTEXT       Please send check or money order only. 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