Your Name:

Title:

Organization:

Address:



City:

State, Zip Code:

Phone Number:

E-mail:
 
Web Site Address:

Please list issues you would like to discuss at Roundtables:

1.
2.
3.
4.
5.

Pre-conference Registration
x $100 =

ACL Member Registration - $420 per person
x $420 =

Non-Member Registration - $465 per person
x $465 =

Guest/Spouse Fee - $150 per person
(Includes all breaks, meals & Friday outing)
x $150 =

First year membership plus registration - $775 per person
x $775 =

Total amount enclosed

Guest/Spouse Names

Payment Method
Visa/MasterCard
Purchase Order
Check


If writing a check, please make your check payable to ACL and mail to:

ASSOCIATION FOR CONSORTIUM LEADERSHIP
C/O The Virginia Tidewater Consortium for Higher Education
4900 Powhatan Avenue
Norfolk, VA 23529-0293
Phone: 757-683-3183
Fax: 757-683-4515 

Conference Registration fees for staff of ACL member consortia include meals, breaks and conference material costs. Other costs are paid through annual dues.

*Non-members may join ACL at the first year regular rate of $350 plus $425 conference fee. This is a savings of $190 over regular non-member registration plus full first-year dues.

All Directors are encouraged to bring at least one staff member.