26th CONNECTIONS
CONFERENCE REGISTRATION

Best Western Lansing-West

Friday,
October 17,
2008

PLEASE COMPLETE THIS FORM. BE SURE TO CHECK THE APPROPRIATE BOXES.

NAME
PLEASE PRINT

TITLE

E-MAIL
ADDRESS

*TUTOR
REGIS-
TRATION
& 
MEMBERSHIP
$25/$30***

*TUTOR
MEMBER-
SHIP
ONLY
$5

**PROF.
REGIS-TRATION
& 
MEMBERSHIP
$85/$95***

**PROF.
MEMBER-
SHIP
ONLY=
$20

             
             
             
             
             
             
             

 

  INSTITUTION:_____________________________________________________________

  OFFICE ADDRESS:_______________________________________________________

  CITY:______________________________________ STATE:_____ ZIP:______________

  PHONE:(        )______________ EXT:______
 
REGISTRATION FEES: Paid Conference fee includes registration and membership to MTA. REGISTRATION
QUESTIONS –
CALL:
Scott Werhnyak
(248) 246-2484

MAIL TO:
Scott Werhnyak, Treasurer
Michigan Tutorial Association
P.O. Box 895
Royal Oak, MI 48068-0895

Or FAX to:
Scott Werhnyak
(248) 246-2481
Before OCT. 1 ***Late
*Tutor/Student $25 $30
**Professional $85 $95
--- LUNCH NOT GUARANTEED FOR LATE REGISTRATION
Make checks payable to: Michigan Tutorial Association -
Total enclosed: $________________

NO REFUNDS

**Tutor - Person employed as a part-time tutor or enrolled as a student and emplyed as a tutor. 
Professional - Person who is actively engaged in the administration or general operation, inclusive of counseling and instruction, of a tutoring program.
The opportunity to join the MTA will also be available at the conference to presenters and others who did not pay a registration fee.