Mentoring: A Key to Iowa's Future

INSTITUTE REGISTRATION

Thank you for your interest in attending the Iowa Mentoring & Induction Institute. Please submit the online form below and we will send you an invoice.

Questions about registration? Contact UNI University Events Coordination at 319-273-5141 or conf-events@uni.edu.

Contact Information

Name

First M I Last

Organization

Organization Contact Information

Work PO Box or Street Address

City

State

Zip

Day Phone
(including area code)

Fax
(including area code)

E-mail

Check here if you DO NOT want your information included in the participant list that will be distributed at the conference.

Check here if you DO NOT wish information about your participation in this program to be shared with news media from your area.

Registration Information

I understand that I will be invoiced $100 at a later time.

I would like more information about credit or would like to enroll in the credit option for an additional $115.00.

Payment Information

Submitting payment: We will send you an invoice with your confirmation letter. American Express, VISA, MasterCard and Discover accepted.

Please bill my company via:

P.O. or Requisition # (make PO to University of Northern Iowa Event Coordination)
Check or credit card

Please bill me direct.

Cancellation Policy
If your plans change and you are unable to attend, please call us at 319-273-5141 or e-mail us at conf-events@uni.edu by June 6 for a full refund of your registration. After June 6, no refunds will be granted. You (or your school/organization) are responsible for full payment of the registration fee regardless of your attendance at the Institute. Substitutions for your registration are always welcome.

Comments & Special Needs
Please provide us with any information that could help make your conference experience a more enjoyable one. You may also use this space to list any special needs, including dietary.

You will receive an invoice and confirmation letter via e-mail.

UNI Events Coordination requests this information for the sole purpose of registering you for this program. We do not routinely release any of this information to anyone outside our institution without express permission. We do ask that you fill out all the registration items that apply to you. We are unable to process forms that do not include your name and address.

The University of Northern Iowa is an equal opportunity educator and employer with a comprehensive plan for affirmative action.

Sponsors
Mildred Middleton, Educator Emeritus
University of Northern Iowa
Iowa Department of Education

In Partnership with
Iowa State Education Association
Heartland AEA 11
West Des Moines Community School District