registration

4^th Annual ICI Instructional Technology Summit
Hosted by: Indiana Wesleyan University
August 10, 2006

REGISTRATION DEADLINE IS August 3, 2006


I am registering for the:	Summit
First Name (as it should appear on name tag)
Last Name
Title
College or University
If you are a vendor, please indicate your company name
Email


Street Address

City
State
Zipcode
Phone Number	(ex: 312-555-1212)


I attended last year's ICI Instructional Technology Summit at Franklin College	Yes No
I would be willing to facilitate a lunchtime Roundtable Discussion	Yes No
Please offer any lunchtime roundtable discussion ideas you may have