ICCI - ENROLLMENT

ICCI Online Enrollment Form
Sunday, May 20 – Wednesday, May 23, 2012

Personal information

First

Last

Professional title, position, department, institution:
Title (Dr., Mr., Ms., other)
Department
Position
Institution
Current professional contact address, e-mail, and telephone:
Current street address
Current city	Current state (enter N/A if not applicable)	Current country	Current zipcode
Current e-mail
Current phone (xxx-xxx-xxxx)
Contact information after April 30 (if different):
Street address
City	State (enter N/A if not applicable)	Country	Zipcode
E-mail
Phone (xxx-xxx-xxxx)
Dietary restrictions:
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Other medical or personal concerns:
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Where did you hear about ICCI?
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Institute Options

Optional pre-conference workshop – Introduction to Internationalization in Higher Education. Cost: $50. 9am-noon on Sunday, May 20:
will attend will not attend

Required – IU Bloomington "A" parking pass. Please indicate if you already have a valid IU "A"parking pass. If not, please indicate whether you will need one or not.
have a valid "A" parking pass will need a valid "A" parking pass will not need a parking pass

Accommodations – participant’s responsibility. . Please indicate if you would like to:
reserve a low cost room on campus in the Willkie Residence Center – $49.40 + 12% / night (paid at Willkie check-in). Call the Willkie front desk (812) 856-4804 and mention "ICCI" when making reservations.
arrange your own accommodations – see Where to Stay.

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You will be e-mailed a link to our ICCI Participant’s Web site for more information. If you have questions, you can always contact us at icci@indiana.edu.

The enrollment fee* is $300. Cancellations must be made in writing to iuconfs@indiana.edu no later than April 30, 2012, to be eligible for a refund, less a $50 administrative fee. No refunds will be issued after April 30.
*The enrollment fee includes two books and all food except one dinner.

Application Complete

By pressing the "submit" button below, your enrollment information will be saved and you will be given the link to the IU Conference page where you will make your online payment.