Online Registration for NITOP 2012

Note: This form is only for participants who will be paying online. If you will be sending a check or purchase order, please use the printed registration form.

Name:

Affiliation for badge, including city and state:

Mailing address:

Address Line 1 (street address):

Address Line 2 (e.g., apartment #):

City: State: Zip:

Phone: Fax:
Email:
Please send me email announcements and important updates about NITOP (just a few times per year)

I will attend the following free workshops on January 3:

Forum: What Have I Got Myself Into? Tips and Strategies for People who are New To Teaching Introductory Psychology, 8:00–9:45 am
Annual STP Workshop: Interteaching: A Practical Pedagogy for Promoting Performance, 8:00–9:45 am
Create Engaging PowerPoint Presentations That Facilitate Great Teaching, 9:00–11:45 am
Improving Online Courses by Improving Connection with Students, 10:00–11:45 am

Annual College Board Workshop: Introductory Psychology from AP through College: Compelling Demonstrations That Work!, 10:00–11:45 am

Roommate request:

Please match me with a possible roommate at the TradeWinds Island Grand (I understand that I will be notified by phone or email
if you are able to do so, and that I will be responsible for making the arrangements/reservations):

My gender: male female
I am a non-smoker
Arrival date
Departure date
Notify me by: phone and/or email

I attended NITOP in
I am a new participant; I learned about NITOP from (check all that apply):

conference brochure by mail
conference brochure from a colleague
announcement in:
electronic news network or website:
recommendation from a past participant (name):

I am a member of: APS APA STP SPSP SIOP
Please accommodate the following special needs:

You will be submitting your payment information on a separate page, but we ask you to indicate your registration information below so that we can keep it with the information you provided above.

Registration fees
   
Regular participant: $515
Student*: $335
Retired faculty: $335
APS regular member: $485
APS student affiliate*: $320
Non-psychologist guest of participant, who will attend meals and breaks: $295
  Name of guest for badge:
   
*To register as a student, you must mail a copy of your student I.D. and fall 2011 course schedule to NITOP, 2303 Naples Court, Champaign, IL 61822 or fax it to 217-355-8668.