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BEST PRACTICES IN BLENDED COURSE DESIGN

July 25-27, 2011 :: San Diego, CA

Attend as a team – remember, if you register as a group, every fourth registrant is free. Questions about the event? Call us at 720.488.6800 to help determine if this event is right for you. Register online at www.academicimpressions.com

REGISTRATION FEES Your registration fee includes: full access to all conference sessions and materials, access to the networking reception on Monday, breakfast and lunch on Tuesday, and breakfast on Wednesday, as well as refreshments and snacks throughout the conference.

Postmarked on or before July 8, 2011 BEST VALUE: Best Practices in Blended Course Design and pre-conference workshop

Best Practices in Blended Course Design (For registrations postmarked after July 8, 2011, an additional $100 fee per registrant applies)

$1395 USD $1095 USD

Check here if you have any dietary or accessibility needs. Please list any needs in the space below and we will do our best to accommodate you.

How did you hear about this event? (email from AI, colleague forwarded email, The Chronicle, etc.) CONFERENCE REGISTRATION INFORMATION (PLEASE PRINT CLEARLY)

Name Job Title Address City Telephone Name Preferred for Badge Institution/Organization _______________________________________________ State/Province _________________________ Zip/Postal Code Email Fax

Country

For registration confirmations and pre-conference communication. (FOR ADDITIONAL REGISTRANTS, PLEASE COMPLETE ADDITIONAL FORMS.)

Additional Contact Name

Additional Contact Phone

Additional Contact Title Emergency Contact Name

________________________________ Additional Contact Email Emergency Contact Phone (day)

(In case of emergency, we will contact this person on your behalf)

(evening) ____________________________________

FREE HIGHER ED NEWS AND ANALYSIS Academic Impressions is happy to offer Higher Ed Impact, a free industry scan of news, trends, and fresh research on higher education, delivered in an easy-to-scan email.

Sign me up for HEI: Daily Pulse impactful news, trends, and practices, sent daily Sign me up for HEI: Weekly Scan – the week’s most critical news, with analysis of top stories and trends, sent on Fridays Sign me up for HEI: Monthly Diagnostic – practical takeaways addressing a strategic challenge facing institutions of higher ed, sent 9-12 times/year

PAYMENT METHOD We accept Visa, MC, and AmEx credit cards. To pay by check, include the check with this form or select the “invoice me” option. Fax form to 303.741.0849 or mail form along with payment to: Academic Impressions, 4643 S. Ulster St. Ste. 350, Denver, CO 80237.

CREDIT CARD Please charge my credit card: (Visa, MC, AmEx) ________________________

Name on Card ________ Account Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Exp. Date ___________Billing Zip Code/Postal Code ___________ Security Code (last 3 digits on the back of Visa and MC __________________

CHECK/INVOICE

My check is included and covers Check # Please invoice me

_______

Purchase Order # (PO# not required to receive invoice)

registration(s)

or 4 digits on front of AmEx)

REFUND/CANCELLATION POLICY Refunds will be issued only if cancellations are received in writing by April 29, 2011. A $100 processing fee will be assessed. After April 29, 2011 a credit (less $100 processing fee) will be issued. The credit will be valid for 12 months and can be used toward any future conferences, Web conferences, audio proceedings, or Web conference archives. In case this event is cancelled, Academic Impressions' liability is limited to a refund of this registration fee only.

Questions about the event? Call us at 720.488.6800 to help determine if this event is right for you.

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