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: kspavin@ku.edu 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 kspavin@ku.edu - 785-864-0502 or Edward Morris ekm@ku.edu - 785-864-4840