Registration Form - The University of Akron

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CHEIRON:
The International Society for the History of
the Behavioral and Social Sciences
47th Annual Meeting, June 18-22, 2015
University of Kansas (Lawrence, KS)
Local Co-Hosts & Organizers: Edward K. Morris & Ruth Ann Atchley
Registration Form
Please use one registration form per attendee.
Contact Information
First Name: __________________________________________________________________
Last Name: __________________________________________________________________
Email address: ______________________________ Telephone: _______________________
Institutional Affiliation: ________________________________________________________
Address Line 1: _______________________________________________________________
Address Line 2: _______________________________________________________________
If US: City:
____________________ State: __________
Zip Code: __________
If Int’l: City: ____________________ Country: _______________
Arrival Information
Date and approximate arrival time in Lawrence: ______________________________________
How will you be arriving? (e.g., car, shuttle, bus, etc.) __________________________
Will you be attending the Opening Reception & Poster Session (open bar, hors d'oeuvres included) on
Thursday, June 18, from 5:30-7:00 p.m.?
Yes
No
Please continue to complete the registration and cost worksheet.
A. Registration Fee
Includes attendance, materials, opening Thursday evening reception, and coffee/tea breaks throughout the
conference.
Adams Alumni Center Website: http://www.kualumni.org/about/adams-alumni-center/
If registering BEFORE May 1, 2015 (check one):
___ Regular Member: $80 (e.g., I am NOT a student registered at a postsecondary institution)
___ Student Member: $60 (e.g., I am a student registered at a postsecondary institution)
If registering AFTER May 1, 2015 (check one):
___ Regular Member: $120 (e.g., I am NOT a student registered at a postsecondary institution)
___ Student Member: $100 (e.g., I am a student registered at a postsecondary institution)
For non-student, non-members, please add one year’s dues of $35 IN ADDITION to the
registration fee above: _____ (Student registration includes Cheiron membership dues.)
The one-day “drop in” registration fee is $40/day. Please check which day(s) you will attend:
Thurs, June 18 ____ Fri, June 19 ____ Sat, June 20 ____ Sun, June 21 ____
No charge for cancellations before May 15, 2015. Afterwards, a $50 charge will apply.
Total Cost of A (Registration Fee): $__________
B. On-campus Housing (Margaret & KK Amini Scholarship Halls) (choose one)
Two-Bedroom Suites, with a bunk bed in each bedroom
The conference location at the Alumni Center is a short, partially up-hill walk.
All prices include linens: towels, pillow, sheets, and a light blanket.
See photos of the hall here: http://housing.ku.edu/margaret-amini#Hall info
Each Suite has one bathroom, one living room, and two bedrooms with 1 set of bunk beds per
room – there are 4 total bed spaces per suite.
Housing Options:
One person in one bedroom w/shared living and shared bathroom with 1 other person.
(2 people in a 4-bed suite, each with a private bedroom)
$50/night(check which nights):
___ Wednesday ___ Thursday
___ Friday ___ Saturday = $ _________
One of three people in a suite w/bunk bed and shared living and shared bathroom with 2 other
people. (3 people in a 4-bed suite. 2 share a bedroom and 1 in a private bedroom –
decided amongst roommates.)
$40/night (check which nights):
___ Wednesday ___ Thursday
___ Friday ___ Saturday = $ _________
One person in a double room w/bunk bed and shared living and bathroom with 3 other people.
(4 people in a 4-bed suite, shared rooms and bunk beds.)
$30/night (check which nights):
___ Wednesday ___ Thursday
___ Friday ___ Saturday = $ _________
Please list the name(s) of the other people with whom you wish to room with (or state “no
preference”): ______________________________________________________
Total Cost of B (Housing): $__________
C. Meals
Breakfasts and lunches will be served at the Adams Alumni Center, in the Bruckmiller Room.
Please check which meal(s) you would like:
Breakfast ($10/day) _____ Friday
Lunch ($15/day)
_____ Friday
_____ Saturday
_____ Saturday
_____ Sunday
Total Cost of C (Meals): $__________
D. Banquet - $55/person
A reception will precede the banquet with an open bar for wine & beer and hors d'oeuvres; cash bar
for liquor. The banquet meal will include wine, a full buffet with salad, two entrée options, sides,
dinner rolls, and dessert.
Total Cost of D (Banquet): $__________
F. TOTAL Payment Amount Due (Total Costs of A + B + C+ D): ______
G. Please check for guided on-campus tours you would like to take (no cost)
___ Allen Fieldhouse Tour (e.g. history of basketball)
___ KU Campus Architectural Tour
___ Visit Roger Barker’s Research Station/Midwest Psychological Field
Station in Oskaloosa, KS (18 miles)
Payment Instructions
1. Please email or mail this completed registration form to:
[email protected]
or
Kelly Spavin
University of Kansas
Applied Behavioral Science Department
1000 Sunnyside Ave. Room 4001
Lawrence, KS 66045
2. Submit payment
 At the Cheiron Event Website via credit/debit card or PayPal account:
https://www.eventbrite.com/e/2015-annual-meeting-of-cheiron-tickets-15561771678
Enter your TOTAL Payment Amount Due (calculated above) in the field “Enter Donation.”
OR
 By mail:
If you live and bank in the United States and would prefer to pay by check, please mail this
completed registration form and a check payable to Cheiron to:
Kelly Spavin
University of Kansas
Applied Behavioral Science Department
1000 Sunnyside Ave. Room 4001
Lawrence, KS 66045
For questions or assistance with registration or payment, please email or call:
Kelly Spavin [email protected] - 785-864-0502
or Edward Morris [email protected] - 785-864-4840
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