Midwest Consortium Conference

Registration Form:

Registration Type:	Student Faculty/Staff Higher Education Administrator National Service Participant (Vistacorps member, Americorps vol., etc.) Community Partner Other
Contact Info:	Last Name: First Name: Prefix: Institution/Org. Affiliate: Employment Title: Employment Address: Employment Phone: Email:
Transportation:	Yes, I will need a parking pass for the University of Nebrask-Lincoln campus lots No, I will not need a parking pass
Meal Preference:	No dietary restrictions Vegetarian Vegan Other

Conference Fees (pick one)

Fees include all meals and breaks shown on the conference schedule, workshop supplies, and parking passes from 3:30 p.m. Thursday, September 21 through 12:00 p.m. Saturday, September 23

$100.00	MCSLHE Members (choose from drop down below)
$40.00	Graduate Students, Undergraduate Students, Community Partners, National Service Participants
$150.00	Non-MCSLHE Members (Higher Education Faculty, Staff, Administrators)

Pre-Conference Fees

Fees include all meals and breaks indicated on the conference schedule, workshop materials, and parking passes from 8:00 a.m. through 3:30 p.m. Thursday, September 21

$50.00

Members, Non-members, Graduate Students, Undergraduate Students, Community Partners, Nationial Service Participants

Student Leadership Conference Fees
(Undergraduate Students Only)

Fees include all meals and breaks indicated on the conference schedule, workshop materials, and parking passes from 8:00 a.m. - 7:00 p.m. Friday, September 22. This $30.00 option is for students who are attending only the Friday Student Leadership Conference. Students who wish to attend the entire conference (Thursday, September 21 - Saturday, September 23) must pay the $40.00 conference fee listed above.

$30.00

Undergraduate Student

Select Pre-Conference Session
(Choose only ONE)

Barbara Jacoby

Barbara Holland

Laverne Barrett

Member Institution
None Central Community College Clarkson College College of Saint Mary Creighton University Dana College Doane College Hastings College Iowa Western Community College Metropolitan Community College Midland Lutheran College Morningside College Mount Marty College Nebraska Methodist College Nebraska Wesleyan College Ogallala College Peru State College South Dakota State University University of Nebraska - Kearney University of Nebraska - Lincoln University of Nebraska - Medical Center University of Nebraska - Omaha University of South Dakota Wayne State College

*Once you submit your form, you will be forwarded to another page that will show you what your total is, and how to send in your payment*