CCID 36th Annual Conference
Registration
Registration cut-off and cancellation deadline: Monday, January 30th, 2012
All fields marked with an asterisk must be completed

Name and Address Information
Full Name: *
Name:
(As it should appear on your name badge) 		*
Position:
Institution: *
Address: *
City: *
State / Province:
Zip:
Country: *
Phone: *
Email: *

The registration fee for "Individual," "Team" (5 or more registrations from 1 institution), "Student" and "Personal Associate" registration covers: all refreshments, Sunday Banquet dinner, Monday Awards Luncheon, and entry to all sessions (EXCEPT FOR Pre-conference Workshops - separate registration for a fee).

Member Fees
(Refer to these lists if not sure - CCID Board, CCID Member, Personal Associates, Outreach Partners)
Individual $350.00
Team (If you do not register all 5 and more team members on the same day, we cannot process your team registration and will charge an individual fee. Thank you for your cooperation). $320.00
Student $170.00
CCID Personal Associate (an Honorary status voted on by the CCID Board) Free

Non-Member Fees
(Refer to these lists if not sure - CCID Board, CCID Member, Personal Associates)
Individual $430.00
Team (If you do not register all 5 and more team members on the same day, we cannot process your team registration and will charge an individual fee. Thank you for your cooperation). $400.00
Student $170.00

Event Registration
Saturday, February 25, 2012 from 1:00 to 5:00 PM The CCID GLOBAL ARENA provides structured yet comfortable and informal environment to learn who.s who among our non-U.S. based attendees, do a little match-making, and determine how to take the next step together. Be there when it all begins!
I plan to attend the GLOBAL ARENA
(CCID Member Institutions and Outreach Partners $0.00 / Non-Members $50.00) 		Yes No

Meal Registration
All meal functions are ticketed.
Tickets for each meal must be presented at the door to the function attendant.
No meals for registered participants can be added after Friday, February 10th 2012.
I plan to attend the Sunday Banquet Dinner Yes No
I plan to attend the Monday Awards Luncheon Yes No
Do you have any dietary restrictions? Please be specific.
(Allergy, Vegetarian, Vegan, Gluten-free, Kosher, No Beef/Pork etc.)


Companion Registration
You may register up to five (5) companions. Tickets for each meal must be presented at the door to the function attendant.
NO companion meals can be added after Friday, February 10, 2012.
NOTE: Need to pay for companions separately? Please finish registering yourself for the conference and return to the Companion registration and payment form later.
Sunday Banquet Dinner (meal ticket required) Add Companions
Companion #1 Name $75.00
Does this companion have any dietary restrictions? Please be specific.
(Allergy, Vegetarian, Vegan, Gluten-free, Kosher, No Beef/Pork etc.)

Companion #2 Name $75.00
Does this companion have any dietary restrictions? Please be specific.
(Allergy, Vegetarian, Vegan, Gluten-free, Kosher, No Beef/Pork etc.)

Companion #3 Name $75.00
Does this companion have any dietary restrictions? Please be specific.
(Allergy, Vegetarian, Vegan, Gluten-free, Kosher, No Beef/Pork etc.)

Companion #4 Name $75.00
Does this companion have any dietary restrictions? Please be specific.
(Allergy, Vegetarian, Vegan, Gluten-free, Kosher, No Beef/Pork etc.)

Companion #5 Name $75.00
Does this companion have any dietary restrictions? Please be specific.
(Allergy, Vegetarian, Vegan, Gluten-free, Kosher, No Beef/Pork etc.)

Monday Awards Luncheon (meal ticket required) Add Companions
Companion #1 Name $55.00
Does this companion have any dietary restrictions? Please be specific.
(Allergy, Vegetarian, Vegan, Gluten-free, Kosher, No Beef/Pork etc.)

Companion #2 Name $55.00
Does this companion have any dietary restrictions? Please be specific.
(Allergy, Vegetarian, Vegan, Gluten-free, Kosher, No Beef/Pork etc.)

Companion #3 Name $55.00
Does this companion have any dietary restrictions? Please be specific.
(Allergy, Vegetarian, Vegan, Gluten-free, Kosher, No Beef/Pork etc.)

Companion #4 Name $55.00
Does this companion have any dietary restrictions? Please be specific.
(Allergy, Vegetarian, Vegan, Gluten-free, Kosher, No Beef/Pork etc.)

Companion #5 Name $55.00
Does this companion have any dietary restrictions? Please be specific.
(Allergy, Vegetarian, Vegan, Gluten-free, Kosher, No Beef/Pork etc.)


Additional Information
Is this going to be your first attendance at the CCID Annual Conference? Yes No
By marking "Yes", you will receive a notification email from CCID as a new attendee to help you learn about the event and CCID.
Dress Code: The conference dress code is business casual for most workshops, plenaries and break out sessions.
Banquet dinner requires after 5:00 attire for both men and women. Thank you.
Model Release: Agree Do not agree
I hereby agree and authorize the use and reproduction by CCID or anyone authorized by CCID,
of any or all photographs, video and radio interviews which CCID has taken of myself, for any purpose as
authorized by CCID, without any compensation to me. CCID may use these photographs/interview quotes for
promotional and information purposes through publications, broadcasts, and website for a period of 5 years
after this registration submission's date.
Cancellation Policy: All cancellations must be submitted to CCID in writing by email, mail or fax. NO calls please.
Cancellation notice received by EOB US Central time January 9, 2012 will be refunded in full.
Cancellation notice received by EOB US Central time January 30, 2012 will be refunded from the paid registration fee minus $180. Refunds will be credited or mailed after March 1, 2012.
No refunds for cancellations received after EOB US Central time January 30, 2012, or for no shows during the conference dates.

Payment Information
Please review the information you have entered above before submitting this registration.
Upon submitting, you will be directed to the payment form where you will be able to print a copy of your invoice. We prefer credit card payments but a check is also acceptable.
Click the Calculate Total button to show your total payment to be remitted to CCID and to proceed to the SUBMISSION button:
Payment Type:
Credit Card
Check
PO #
 Total: $
Make checks payable in US dollars only to: CCID Executive Office
Mail checks to:CCID Executive Office * PO Box 2068 * Cedar Rapids, Iowa 52406-2068 * USA