2015 Irc Conference Registration Form - Illinois Reading Council
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1
22015 IRC Conference
Return this form with payment to:
Illinois Reading Council
Registration Form
203 Landmark Drive, Suite B
Normal, IL 61761
October 1 - 3, 2015
Or fax to: (309) 454-3512
Or register online at
Peoria, Illinois
ONE NAME ON EACH FORM
Please print or type. Form may be reproduced.
Name (Last)________________________________________ (First)____________________________________________________
School/Business_____________________________________ City_____________________________________________________
Home Address_______________________________________ City____________________ State____________ Zip____________
Telephone (
) ____________________________ Email (
)_________________________________________
Confirmations sent by email
Position/Grade Level? ________________
Presenting at Conference? ___Yes ___ No
Are you an IRA member? ___Yes ___ No
REGISTRATION
(check one) includes sessions on Thursday, Friday, and Saturday.
On or Before August 15, 2015
After August 15, 2015
Registration for IRC Member:
____Current IRC Member (Membership Number: ________________________) . . . . . . . . $165
$190
____Retiree (Member) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $25
$50
____Preservice Teacher with ID (Member) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $25
$50
Combined Registration ($160) & Membership
($45)–Savings of $5
____Select Local Council from Membership Form (Council: ____________________) . . . $205
$230
Registration for Non-Member
____Non-Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $240
$265
____Retiree
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $50
$75
(Non-Member)
____Preservice Teacher with ID
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $50
$75
(Non-Member)
MEALS
Meals are optional. Check choice of menu. Include payment with registration.
____Thursday Breakfast (Pere Marquette Ballroom) . . .
Richardson and Walther
. . . . . $20
$25
_____Scrambled Eggs & Bacon
_____Vegetarian
____Thursday Luncheon (Peoria Civic Center Ballroom) . . .
. . . . . . . . . . $25
Dave Burgess
$30
_____Cheese Tortellini with Roasted Tomato Coulis
____Thursday Luncheon (Pere Marquette Ballroom) . . .
Jane Yolen
. . . . . . . . . . . . . . . $25
$30
_____Taco Salad
_____Vegetarian
____Thursday PSA Banquet (Peoria Civic Center Ballroom) . . .
James Howe
. . . . . . . . $33
$38
_____Herb & Apple Brandy Chicken
_____Vegetarian
____Friday General Session (Peoria Civic Center Theatre) . . .
. . . . . . . . . . . FREE
Dav Pilkey
FREE
_____Donuts and Coffee
____Friday Breakfast (Pere Marquette Ballroom) . . .
Donalyn Miller
. . . . . . . . . . . . . . . $20
$25
_____Cinnamon French Toast
_____Vegetarian
____Friday Luncheon (Peoria Civic Center Ballroom) . . .
. . . $50
IL Reads Author & Book
$55
_____Southwest Chicken Salad
_____Vegetarian
____Friday Luncheon (Pere Marquette Ballroom) . . .
Penny Kittle
. . . . . . . . . . . . . . . . . $25
$30
_____Grilled Chicken Wrap
_____Vegetarian
____Friday Night Pizza Party for Preservice Teachers Only . . . . . . . . . . . . . . . . . . . . . . . FREE
FREE
____Friday Banquet (Pere Marquette Ballroom) . . .
Cris Tovani
. . . . . . . . . . . . . . . . . . . $33
$38
_____Herb Roasted Chicken
_____Vegetarian
____Saturday Breakfast (Pere Marquette Ballroom) . . .
. . . . . . . . . . . . . . . . . $20
Jim Burke
$25
_____Scrambled Eggs & Sausage
_____Vegetarian
____Saturday Author Luncheon (Pere Marquette Ballroom) . . .
. . . . . . . . $27
Louis Sachar
$32
_____Stuffed Chicken Breast
_____Vegetarian
METHOD OF PAYMENT
TOTAL AMOUNT ENCLOSED
$_____________
$_____________
(Sorry, NO Purchase Orders accepted!)
Check (payable to IRC)
Mo.
Yr.
Credit Card
Signature ________________________________________
Credit Card
(Visa, MasterCard, Discover)
Expiration Date
Special Accommodations – Individuals who need special accommodations must make specific requests in writing to the IRC office at least three weeks prior to the conference.
Cancellation/Refund Policy – Requests must be made in writing by September 15, 2015. Please see the complete policy under General Conference Information or at the IRC Website.
Unless notified in writing, this registration constitutes an agreement that the registrant’s image, likeness, and appearance can be used in photographs of such events and activities.
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