Mount Rushmore Institute Registration Form

Personal Information

First Name:
Last Name:
Badge Name
Job Title:
Organization:
Address #1:
City:
State:
Zip Code:
Work Number:
Fax Number:
Alternate Number:
E-Mail:

Please check all that apply:
COABE Member
COABE Board Member
SDALL Member
SDALL Board Member
Adult Learner*
Presenter
Administrator
Teacher
Full Time Student
Volunteer
Retiree
Conference Committee
Adult Education
Higher Education
Corrections
Exhibitor
After School Program Community Education Other:
* Current or former student of an AEL/ABE/ESOL Program

Membership Registration

	SDALL Membership (Individual Membership Only)	$15.00
Total:

Conference Registration
Early bird registration must be postmarked by June 1, 2008
Registration accepted until July 10. There will be NO on-site registration.

Are you a SDALL Member? YesNo

Early Bird Conference Registration
Late Registration

SDALL Member	Non-Member
$160	$190
$190	$220
Total:

Conference Meal Function/Special Events Registration
SDALL Awards Lunch (Wednesday, July 30)

Registrant not attending meals	$0
Registrant attending meals	$0
Fee Per Guest	$15
Total:

I will need vegetarian meals for this event

July 28-29 Registration for Institute Strands
Select the Institute Strand you would like to attend on Monday, July 28 and Tuesday, July 29. Please indicate a 1st and 2nd choice below adjacent to the strand you would like to attend. Space is limited. For registrations received prior to July 1st, every effort will be made to honor your first choice. Topics are subject to change based on speaker availability.

First Choice:

Second Choice:

July 30 Registration for Institute Strand
Select the Institute Strand you would like to attend on Wednesday July 30. Please indicate a 1st and 2nd choice below adjacent to the strand you would like to attend. Space is limited. For registrations received prior to July 1st, every effort will be made to honor your first choice. Topics are subject to change based on speaker availability.

First Choice:

Second Choice:

Tours & Tickets Registration

Select the Tours you will attend during the 2008 Institute!

Crazy Horse / Mount Rushmore Tour Monday, July 28, 2008 \| 4:45-9:45	$40x tickets =	$
Gold Dust Deadwood Tour Tuesday, July 29, 2008 \| 4:45-11:00	$10x tickets =	$
Gold Dust Deadwood Tour with Historic Area Tour Tuesday, July 29, 2008 \| 4:45-11:00	$16x tickets =	$

Payment Information

Indicate your payment terms below
Thank you for your registration!

Total Membership Registration
Total Conference Registration:
Total Conference Additional Meal Registration:
Total Tours Registration:
Total Amount Due:

Check (payable to "SDALL")

Check Number (optional): *Registration will not be considered complete until check is received

Purchase Order

P.O. Number:
Organization:
P.O. Billing Address:

P.O. Contact Person:

Pay with a credit card through Paypal

Register in 3 Easy Ways:

By Mail: SDALL, 33 3rd ST SE, Suite 202, Huron, SD 57350
By Fax: 605-353-7314
Or by submitting this form electronically (Press the Submit Registration button)