Registration Form

* 1. First Name

* 2. Last Name

* 3. Institution:

* 4. Institution City:

* 5. Institution State:

* 6. I am from:

* 7. E-mail address:

* 8. Conference Registration fees include continental breakfast, lunch, and snacks.
Lunch will be a Boxed Lunch.

Please click "Yes, Please" if you want a vegetarian lunch - thanks!

* 9. $60.00 Attendee

* 10. $45.00 Presenter

* 11. $30.00 Library Science Student

* 12. Total Amount enclosed:

Registration after Friday, March 31, 2017 will be $70.

* 13. I want my contact information included in conference handouts.

Please make your check payable to: DALINC. We will also accept credit cards or purchase orders. To pay by credit card, use the PayPal link on the Registration web page .

* 14. I paid by:

If paying by check or purchase order, please make out check to DALINC and mail funds and registration form to:
DALINC
c/o Susan Ebertz, Treasurer
Reu Memorial Library
333 Wartburg Place
Dubuque, IA 52003

Or you may fax your PO and registration form to 563-589-0296. Upon receipt of registration and payment a confirmation e-mail will be sent to you.

If you have registration questions, please email Susan at sebertz@wartburgseminary.edu.

Thank you!

T