Conference Fee:

1. Conference Registration Form Please photocopy this form for additional registrants. One form for each registrant please. NorthEast and Mid-Atlantic Millennium Users Group ConferenceThe Rome Commons Ballroom, University of ConnecticutWednesday, September 22, 2004 • Name • Institution • Address • City State Zip • Daytime Phone ( ) • Method of Payment: •  Check payable to UConn •  Mastercard  Visa  Discover • Card Number Expiration Date • Name on Card Signature • To register: • Mail this form to: University of Connecticut, Professional Studies, One Bishop Circle, Unit 4056, Storrs, CT 06269-4056. • Phone: 800-622-9905 or 860-486-1052 Fax: 860-486-5221 • Online registration URL available on listserve email. Conference Fee:  $85per person to include cost of conference registration, materials, continental breakfast, buffet lunch, morning and afternoon refreshment breaks. Hotel Fee: $89per room/ per night, single or double, Nathan Hale Inn and Conference Center. Please circle single or double; please list the nights you would like reservations. We will make the reservation for you. 9/21/04 9/22/04 $ Total amount enclosed or to be charged Refunds The registration fee is refundable, less $30, up to three days prior to the day of the program. Registrants who do not cancel are subject to the entire fee. Participant substitutions may be made at any time. The College of Continuing Studies reserves the right to cancel or reschedule a program in the event of insufficient enrollment or unforeseen circumstances.