7/27/2019 iCamp iPad Day Registration Form

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Registration Information

_______________________________________

Location & Parking

Sessions will be located as follows:

The iCamp iPad Day will be held in Bluemont Hall

on the K-State campus on January 15, 2014.

Conference participants intending to park on campus

are required to purchase a parking permit. Permits

(including the parking garage) are $5 per day and maybe purchased by checking the appropriate space on

the registration form. Prepayment for permits is

required. Parking in the parking garage without a

permit is $1.50/hour. Additional parking information

will be provided in your registration information.

Registration

Registration for the Day will begin at 7.30 a.m. The

conference will begin at 8:00 a.m. and will conclude at

3:00 p.m. Lunch is included in your registration fee.Space is limited so early registration is recommended.

The conference registration fee will be refunded in full

(less a $10 administrative fee) if notification is

received by 5:00 p.m. on January 10. For questions

regarding registration procedures, please call 785-

532-5569 or toll free to 1-800-432-8222.

Special Assistance

Kansas State University is committed to making

conferences accessible to all participants. Aparticipant in a conference or non-credit program with

a disability who needs accommodations or has special

dietary requirements should indicate the services

needed at the time of registration. If you have further

questions please contact Tony Ballard at 785-532-

2402 or 1-800-622-2KSU. Early notification is

requested to ensure that accommodations can be

provided in a timely manner.

Registration Procedures

You may mail this to the address below, FAX it to (785) 532-

2422 or PHONE (785) 532-5569 or visit

https://www.smore.com/qax0 to register securely online.

Registration Form (please print)

_____________________________________________

Last Name First Name MI_____________________________________________

Position School District #_____________________________________________School Name and Address

_____________________________________________Billing Address if Different from Above

_____________________________________________Daytime Phone FAX Number

e-mail _______________________________________

____________________________________________List Special Assistance or Dietary Needs

Registration Amount

______ $25.00

______ $5.00 Parking Permit

$ ________ _______ _______Total Amount Paid by Paid by

District Registrant

Method of Payment

___________ Check enclosed (make payable to

Kansas State University)

___________ Purchase Order enclosed # _______

Photo Release"You may use my photo for educational, news, or

promotional purposes including but not limited to marketing

materials or the organization's website."

________ Yes ________ No

Roster Release"You may print my name, affiliation, address (US

mail/email/WWW) and telephone/FAX number in the roster

of participants."________ Yes ________ No

Return this form to:

iCamp iPad Day, Division of Continuing Education, 1615

Anderson Ave, Suite 141, Kansas State University,

Manhattan, KS 66502-4098