BenchMark 3.5 Registration

Required Data for Registration System

1.	Name
2.	Title
3.	Center/Institution
4.	Address
5.	City
6.	State
7.	Country
8.	Telephone
9.	Fax
10.	E-mail
	Confirm E-mail
11.	Skype Username (if known)

12.	Do you have a professional Facebook or Twitter Account? Yes No     If yes, please provide:
	Facebook:
	Twitter:
13.	Would you prefer to receive conference materials electronically or via hard copy?
	Electronically Hard Copy
12.	Please list your area(s) of academic interest, specialty, focus and/or teaching.
13.	Do you have any dietary restrictions? If so, please list them.
14.	Do you have any accessibility restrictions? If so, please list them.
15.	Have you attended any of the previous conferences held in 1986, 1996 or 2006? If so please, indicate those you have attended.
	2006 1996 1986
16.	Where did you hear about BenchMark 3.5? Website (please specify), flyer, listserv posting, e-mail, word of mouth, other (please specify).
17.	Do you want an exhibit at the vendor fair? Yes No   Exhibitor details (new window)
18.	Do you want to submit an advertisement for the conference program? Yes No   Advertisement details (new window)
19.	Change Image To help protect against spam, please type the numbers in the image above:
20.	Full Conference Rate Student Rate

Click on the PayPal button below to complete your registration and pay your registration fee online. PayPal accepts credit cards and online transfers.

When you click this button, a new window will open so that you may also make your hotel reservations. If you prefer, you can also click on this link or visit our main BenchMark 3.5 page.