Mail-In Registration Form

Sixth
NEBRASKA SUMMIT
ON
DISTANCE EDUCATION & TELEHEALTH
 

June 5-6, 2007

College Park
3180 West U.S. Highway 34
Grand Island, NE 68801

NAME:

TITLE:

ORGANIZATION:

STREET:

P. O. BOX:

CITY:

STATE:

ZIP:

PHONE:

EMAIL:

REGISTRATION FEES:

Registration includes Tuesday & Wednesday conference, events & meals, including dinner at Plum Creek Station & one year membership in NDLA...

For information on motel accommodations, call the Downtown Holiday Inn and be sure to tell them you are with the "Nebraska Distance Learning Conference." The phone number is 308-384-1330 or 1-800-465-4329.

Before June 1st: $60

$

After June 1st: $70

$

 I plan to attend the dinner at Plum Creek Station on Tuesday evening, June 5, 2007 (included in registration).
 Please add  extra reservation/s for Tues. evening meal @ $10 per person   $

TOTAL ENCLOSED:

$

PAYMENT OPTIONS:

Please make Check or Purchase Order payable to NDLA and mail completed Form & Check or P.O. to:

NDLA
Attn: Patricia S. Hoffman
..
Video Services Facilitator
Information Technology Services
985170 Nebraska Medical Center
Omaha, NE 68198-5170

For questions:
Telephone:
402-559-7609

'See you in Grand Island on June 5-6!