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Registration Form
JSA Professional Development Workshop
History, Culture, and Society: Japan Moving into the 21st Century
October 4-6, 2018
Johnson County Community College
Registration deadline: 28 September 2018
Participant Information
*
Indicates required field
1. Name
*
First
Last
2. Institution
*
3. Academic position
*
4. Academic discipline
*
5. Professional (institutional) address
*
Line 1
Line 2
City
State
Zip Code
Country
6. Work phone
*
7. Cell phone
*
8. Preferred e-mail (shared with workshop participants)
*
Logistics
The $200 registration fee includes
two lunches, a dinner at the Rozelle Court Restaurant at the Nelson-Atkins Museum on Friday night, and a ticket to the Greater Kansas City Japan Festival on Saturday.
Workshop participants are responsible for their own hotel reservations. JSA has negotiated a special group rate at
the DoubleTree by Hilton Kansas City - Overland Park at 10100 College Boulevard, Overland Park, KS 66210. The group rate includes breakfast and wifi for $117/night plus taxes and fees.
9. Payment (please choose one)
*
I will make the registration payment myself online
My institution will make the registration payment online
I will pay the registration fee by check
My institution will pay the registration fee by check
10. Lunch, Thursday, October 4
*
Turkey Sandwich
Vegetarian Sandwich
11. Lunch, Friday, October 5
*
Chicken Salad
Vegetarian Salad
12. Dinner, Friday, October 5
*
Salmon
Vegetarian Entree
13. Food allergy or intolerance:
*
No
Yes
Please specify
*
14. How did you find out about this Workshop?
*
15. Any comments?
*
Registration payment by check
If payment by check is your preferred option, please complete this registration form, print it out and mail it to Prof. Stacia Bensyl together with your check to the following address:
Stacia Bensyl
Professor of English and JSA Treasurer
Department of English, Eder Hall 222-I
Missouri Western State University
St Joseph, MO 64507
Alternatively, complete the registration form, save it as a Word Document and e-mail it to Prof. Bensyl at
[email protected]
. Please indicate in your e-mail the date on which you have mailed your registration fee.
A receipt of payment and confirmation of registration will be issued once we have received both your payment and registration.
Submit registration form