NOTE: This form cannot be completed online.  Please print, fill out and mail to the address listed at the bottom of the form.  Thank you!

Registration Information:

         Yes, I want to attend the Conference: Enclosed is my $35.00 Pre-Registration fee, (postmarked by Friday, October 26, 2007), which includes lunch and membership.

          $20.00 Pre-Registration for Students & Seniors (65+)

       $20.00 for Vendors and Exhibitors (no membership included)

_____ I cannot attend the Conference, but I want to join ATN. Enclosed is my $15.00  

          (Membership Only) check made out to “ATN.”

_____ I’m enclosing an additional donation to ATN of $________.

$5.00 additional for on site registration (no lunch guarantee)

Please Carpool! Parking is limited at Selu so we ask that you would ride together if possible.

Lodging:  On-campus lodging is not available, but we sometimes get special rates with local hotels. Please call or email and inquire.

Attendees qualify for re-licensure points.

 ATN is a membership-based organization, so we need your financial support.

Name: ____________________________     Email Address: ______________________

Address: __________________________      Work Place: _________________________

__________________________________    Work Phone: ________________________

__________________________________    Subject and Grade Taught: _____________

Home Phone: _____________________­__                 School or Institution___________________

Are you an AASIS Mentor/Teacher?_______________    

Send to

Kerri Huff, ATN 

Box 7014, Appalachian Regional Studies Center

Radford University

Radford, VA 24142

Call (540) 831-5366 or FAX (540) 831-5951

Email:  khuff@radford.edu

Visit our Website: www.radford.edu/arsc