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Personal Information:
Mr./Mrs/Ms./Dr.
Name:
Address:
City:
State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code:
Name for Name Badge:
Phone:
Fax:
Name of Organization:
Organization website address:
Title:
Email Address:
Status:
College Member
Student Member
Employer Member
Associate Member
Substitute for Member
Name of member sponsoring substitute:
Non-member
Spouse/Partner/Guest
Conference Registration: (Includes conference fee, President's Reception, all meals and banquets except Monday's dinner)
Full Conference (to select more than one option, hold down the control key, or the Apple key if on a Mac)
Please Select from the following menu options... Member/Substitute (Early Bird -- By April 13, 2001) $325 Member/Substitute Registration Fee (Non-Early Bird) $375 Non-Member (no Early Bird available) $475.00 Student Member (no Early Bird available) $150.00 Spouse/Partner/Guest (no Early Bird available) $250.00 Honorary Member (no Early Bird available) $150.00
Daily Registration Options
Sunday Member/Substitute (daily) $75.00 Sunday Non-member (daily) $125.00 Sunday Student Member (daily) $125.00 Sunday Spouse/Partner/Guest (daily) $100.00 Sunday Honorary Member (daily) $40.00 Monday: Member/Substitute (daily) $175.00 Monday Non-member (daily) $225.00 Monday Student Member (daily) $80.00 Monday Spouse/Partner/Guest (daily) $150.00 Monday Honorary Member (daily) $80.00 Tuesday Member/Substitute $175.00 Tuesday Non-member (daily) $225.00 Tuesday Student Member (daily) $80.00 Tuesday Spouse/Partner/Guest $150.00 Tuesday Honorary Member (daily) $80.00 Wednesday Member/Substitute $75.00 Wednesday Non-member (daily) $125.00 Wednesday Student Member (daily) $40.00 Wednesday Spouse/Partner/Guest (daily) $100.00 Wednesday Honorary Member (daily) $40.00
Sunday Afternoon Entertainment
Buck's County 2 Hr. Tubing Trip $25.00
Atlantic City Trip $25.00
History Philly Trolly Tour $25.00
New Professionals Workshop (Add'l cost of $50):
Will attend: Yes No
Total cost:
Cancellation/Refund Policy
Refund Requests for conference registration must be received in writing by Friday, 11 May 2001. Requests received by this date will be refunded in full minus a $25.00 processing fee. No refunds shall be granted after 11 May 2001.
Hotel Registration
All hotel reservations must be made through Connections by calling 1-800-262-9974 or visiting their website at connectionshousing.com. Click on Eastern Association of Colleges and Employers; the password is PHILLY.
Special Diet Information
Vegetarian
Other
Special Needs
If you have a disability that requires accommodation, please indicate the necessary accommodation(s):
Payment
Check (must accompany registration form) Make checks payable to: Eastern Association of Colleges and Employers, Inc.; EACE's Federal Tax ID #: 23-7085303
Please note: credit card information is not sent to a secure server.
Credit Card (please indicate: Visa Mastercard NOVUS
Card Number:
Expiration Date:
Name as it appears on the card:
Contact Information
Please return this form with a check or credit card information to:
By mail:
Carol Lyons Northeastern University Department of Career Services 101 Stearns Center Boston, MA 02115 By fax: (617) 373-8656 Questions? Email or call Carol Lyons at ca.lyons@neu.edu or (617) 373-3442.