REGISTRATION/MEMBERSHIP FORM CONVENTION REGISTRATION: COLLEGE LANGUAGE ASSOCIATION Federal Tax ID #: 22-2769408
April 8-11, 2015 Sheraton Dallas Hotel 400 North Olive Street Dallas, Texas 75201 (214) 922-8000 Reservations: College Language Association (OR copy and paste the following link into a web browser) https://www.starwoodmeeting.com/StarGroupsWeb/res?id=1411183760&key=36338499 Hotel Registration cutoff: March 9, 2015
NAME: Title______ Last
First
MI
ADDRESS: _____________________________________________________________________ CITY
STATE
ZIP__________________
E-mail address: __________________________________________________________________ College/University Affiliation: ______________________________________________________ Please Check Applicable Items. Total Fees Enclosed: $__________________ Pre-Registration for Convention: ____Regular $130.00 ___Student $115.00 ___Retiree $115.00 2013 Annual Membership (if not already paid): ____ Regular $80.00
____Student $55.00
____Retiree $55.00 ____ Life $500.00 (4 - $125.00 payments) Make checks or money orders payable to College Language Association and mail to: Dr. Yakini Kemp, Treasurer • P.O. Box 38515 • Tallahassee, FL 32315 • Pay by credit card. Please write card number [VISA, MC, Discover]: ____________________________________________________________________________ Expiration Date: __________________________ Billing Zip Code for card _______________ Signature: Phone contact for card holder: ______________________________________________ Treasurer’s Office: (850)561-2608 • Email:
[email protected] • Website: www.clascholars.org Fax: (850) 386-6361 NOTE: NO REFUNDS after March 16, 2015 ** On-site registration: Regular $145.00 Student $130.00 Retiree $130.00**