Registration Form

Step One:  Fill out the information below

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Office Phone
Home Phone
Other Phone
E-mail

Affiliations

Institution(s)
Union(s)
Professional Association(s)

Languages

Preferred language(s):
I can understand presentations in: 

Translation will be provided based on need.

Place an "X" in all the boxes below that apply to you:

I teach at a . . .

Community college
Public College/University
Private college/university
For-profit school
Other organization:  

I consider myself to be . . .

A union member
A contingent instructor
A potential “conference buddy” (see Mentor Match-up in this brochure)
A new activist
An elected or appointed union leader
A paid union staff member
A graduate employee
A full-time non-tenure-track instructor
A labor educator
A researcher on contingent labor or higher education

Caucuses

Please indicate (with an "X") if you would be interested in participating one or more of the following caucuses. Members of these groups and allies are welcome.

People of color
Women
Lesbian/Gay/Bisexual/Transgender
Other:  

Other Accommodations

Please list any special diet or accessibility concerns. Also, if you would like to take advantage of childcare, please list the ages of your children. We will do our best to accommodate you. Do not hesitate to contact us for more information.
Diet:
Accessibility:
Childcare:

Prickett/Wakefield Award

Optional: Nominate an activist for the award.

Registration Fee

Includes some meals
1.  Early registration--extended (postmarked or submitted online by Apr. 9): $100 (U.S.)
2.  Late registration (after Apr. 9): $150

Subtotal:

Optional Events

Please indicate how many of each (if any), you'd like to purchase.

3.  Saturday night dinner/open bar $30/person

Subtotal:  

4.  Thursday afternoon neighborhood mural tour $20/person
Subtotal:  

5.  Monday morning Haymarket labor history tour $20/person
Subtotal:  

6.  Second City improvisational comedy event
$15/person w/ registration
$20/person at the door (Sunday night)
Subtotal:  

7. Contribution to scholarship fund for participants without institutional funding.
$10 $25 $50

TOTAL ENCLOSED: $

How will you pay?

By check - After you confirm your entries below, click on the Pay by Check button. This will open a new window, with all your information on it. Print this out and submit it by mail with your check to the address indicated in that new window. 

By credit card (Pay Pal) - After you confirm your entries below, click on the Pay Pal button. This will take you to a shopping cart page where you'll click on the appropriate "Add to Cart" buttons.  When you're ready to check out, you'll be taken to a secure Pay Pal page.  You will need to have a Pay Pal account, but you can set one up easily from that page.


STEP 2:  Confirm Your Entries

You must confirm your entries by clicking on the "Confirm" button below.  Actually, this sends the registration information to COCAL, so you won't be officially registered unless you complete this step.  After that, you should click on the payment button.

Check payers should go here.

Credit card (Pay Pal) payers should go here.


Check Payers

Name
Address
Work Phone
Home Phone
Other Phone
E-mail
Institution(s)
Union(s)
Professional Association(s)
Language(s) preferred
Language(s) understood


I teach at . . . Community College Public College/University
Private College/University For Profit school
Other
I consider myself to be . . . Union Member Contingent instructor
Conference Buddy New Activist
Union Leader Union Staffer
Graduate Employee FT Non-Tenure Track
Labor Educator Researcher
Caucuses People of Color Women
LGBT    
Other

Diet
Accessibility
Child Care
Award Nomination

 
Registration Early Late $   Subtotal
Saturday night dinner Number $   Subtotal
Thursday mural tour Number $   Subtotal
Monday Haymarket tour Number $   Subtotal
Second City improv event Number $   Subtotal
Scholarship Contribution $10
$25
$50
Total money to submit $  

If you see any mistakes, please correct them above (where you originally filled out your entries) and be sure to then click on the Confirm Button again. When your entries are correct, click on the pay button below.

You should ignore this box:


PayPal Payers

Name
Address
Work Phone
Home Phone
Other Phone
E-mail
Institution(s)
Union(s)
Professional Association(s)
Language(s) preferred
Language(s) understood


I teach at . . . Community College Public College/University
Private College/University For Profit school
Other
I consider myself to be . . . Union Member Contingent instructor
Conference Buddy New Activist
Union Leader Union Staffer
Graduate Employee FT Non-Tenure Track
Labor Educator Researcher
Caucuses People of Color Women
LGBT    
Other

Diet
Accessibility
Child Care
Award Nomination

 
Registration Early Late $   Subtotal
Saturday night dinner Number $   Subtotal
Thursday mural tour Number $   Subtotal
Monday Haymarket tour Number $   Subtotal
Second City improv event Number $   Subtotal
Scholarship Contribution $10
$25
$50
Total money to submit $  

If you see any mistakes, please correct them above (where you originally filled out your entries) and be sure to then click on the Confirm Button again. When your entries are correct, click on the pay button below.

You should ignore this box:


Last revised on September 25, 2005 by the
Webmaster.