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ISLMA 2017 Conference Registration Form

Save time and register through our online registration form. This form is completely secure. Please fill it out completely and submit the form to ISLMA. If you wish to print and mail a registration form, please view and print the .pdf version here (requires Adobe Acrobat software browser plugin).

All fields are required to be filled in so that we may completely process this online form.

First Name: (as you want it to appear on name tag)
Last Name: (as you want it to appear on name tag)
School/Organization:
Grade Level:
Work Address:
City:
State:
Zip Code:
Work Phone:
Work Fax:
Home Address:
City:
State:
Zip Code:
Home / Cell Phone:
Cell Phone:
Check Preferred Address: Work Home
Email Address:
Please provide your IEIN
(if you wish to claim Professional Development Hours.)

(Illinois Educators Identification Number)
Are you an ISLMA Member?
(Non-member conference registration includes membership through 6/30/18.)
Yes No
Are you presenting? Yes No
Are you on the 2017 Conference Steering Committee? Yes No
Is this your first ISLMA Conference? Yes No
Check here if you have a disability and require special services:
Please indicate services needed:
 

Professional Development Seminars

Thursday, October 19

Note: See inside for details of these seminars. There is a fee separate from the conference fee to attend the Professional Development Seminars. You must indicate 1st, 2nd, and 3rd choices for each session. One half-day session is $85; two half-day sessions are $135. All half-day sessions will receive 3 hours of credit for professional development. Lunch will be on your own.


Thursday Morning Seminars, 9:30 a.m. to 12:30 p.m.
Seminars Desired:

Choice:
in order of preference
Seminar Description:

First
Second
Third  
1. Passion in Action-Getting READiculous with Kids, Alissa Henkel & Susan Bishop
2. What’s New in Children’s Books 2017, Deborah B. Ford
3. Best Books for Middle School, Jonathan Hunt
4. Going Green (Screen) in the Library, Kathy Garneau
5. Beyond Monopoly and UNO: Tabletop Gaming in the Library, Amy Williams
6. You Have What It Takes to Be a Future Ready Librarian, Britten Follett

Thursday Afternoon Seminars, 2:00-5:00 p.m.
Seminars Desired:

Choice:
in order of preference
Seminar Description:

First
Second
Third
 
7. Hacking Literacy with Maker Education, Colleen Graves
8. Library: Lame or Legit?, Kurt Stroh
9. Best Books for High School, Jonathan Hunt
10. Social Justice in Youth Literature, Karla Lucht
11. Unpacking the AASL Toolkit for Promoting School Library Programs, Jacob Roskovensky,

Thursday Evening Seminar
 Maker Space Event – Colleen Graves

Note: Maker Space Event is included in your conference registration fees. Please indicate if you plan to attend.
If you are not attending conference but want to attend the Maker Space Event, please see the registration form for Maker Space on the ISLMA website.

  I will attend the Maker Space Event.

"A" Seminars Total: $

Conference Registration Fees

Friday, October 20 and Saturday, October 21

To qualify for the member rate, you must be a 2017-2018 ISLMA “Member of record.” The non-member fees include a one year ISLMA Membership and subscription to ISLMA News. Please see registration fees.

MEMBERSHIP TYPE
FULL CONFERENCE
SINGLE DAY (Check One)
 
EARLY BIRD
register by 9/13/2017
REGULAR
register by 10/6/17
ON-SITE
after 10/6/17
EARLY BIRD
register by 9/13/2017
REGULAR
register by 10/6/17
ON-SITE
after 10/6/17
Member
$165
$195
$225
$150
$180
$210
Retired/Student
Member
$130
$160
$190
$120
$130
$160
Non Member
$240
$270
$300
$225
$255
$285
Colleague:
Para/Admin/Teacher
$160
$160
$160
$130
$130
$130

I am a:
Member
Retired/Student Member
Non Member
Colleague (paraprofessional, administrator, classroom teacher)

------------------------------------------------------------------------------------------------

I'm An Early Bird Registrant (registering before 9/13/2017)
I'm Registering at the Regular Rate (registering by 10/6/17)
I'm Registering On-Site (registering after 10/6/17)

------------------------------------------------------------------------------------------------

I'm registering for Full Conference
Friday only
Saturday Only

"B" Registration Total: $ 

Meals: (MUST BE PRE-REGISTERED) Complete menu details are on the ISLMA website.

Check if you have special dietary requirements. A committee member will contact you for details.

Thursday, October 19

LUNCH AND DINNER ON YOUR OWN. – There are a variety of restaurants in the area.

Friday, October 20

Buffet Breakfast (included in registration fee)

Annual Membership Meeting and Brown Bag Lunch (included in registration fee)
   Select one:
       Italian Sub
       Eggplant Di Buffalo
       Turkey

Award Banquet - $50.00
   Select one:
       Chicken Pizzaiola
       Spiced Short Rib
       Squash Lasagna

Saturday, October 21

 Author Awards Breakfast - $35.00
Scrambled eggs, potatoes, bacon, fruit

 Buffet Lunch (included in registration fee)

"C" Meals Total: $
Total of + + = $

Credit Card or Purchase Order
Mail completed form with check made payable to ISLMA or mail a copy of Purchase Order to ISLMA Conference Registration, PO Box 1326 | Galesburg, IL 61402-1326 or fax to 309-341-2070.

Complete the following information below.

Payment Options: Credit Card (online payment)         Check          Purchase Order
 
Please enter your billing information:
Card Number: (We accept VISA and MasterCard)
Expiration Date: /
CCV: (3 or 4-digits on the back of your card)
If you would like to use a Purchase Order, please indicate below:
PO Number:
PO Date:
Full Name of the School District:
Address:
City:
State:
Zip Code:

   

Comments

 

REGISTRATION QUESTIONS?
Caroline Campbell, Registrar
Phone: 309-387-6275
Email: registrar@islma.org

OTHER QUESTIONS:
Becky Robinson, Executive Secretary
Phone: 309-341-1099
Fax: 309-341-2070
Email: execsecretary@islma.org

SPECIAL INSTRUCTIONS:

  • Use a separate form for each person registering (photocopy).
  • Registration form must be postmarked by September 13, 2017 (Early Bird) or October 6, 2017 (Regular).
  • Online Registration is available through the ISLMA website (http://www.islma.org). Online registrations must be received by
    midnight of the Early Bird and Regular dates listed.
  • Requests for refunds must be received in writing by October 13, 2017.
  • Cancellations will result in a $25 handling fee.
  • Refunds will be made after the conference.
  • Confirmation will be sent for registration received by October 6, 2017.
  • Hotel reservation must be made directly with the hotel by September 27, 2017.
  • Please remind your district personnel to process this form in time to meet registration deadlines.

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Date Modified: 7/25/17

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Illinois School Library Media Association | PO Box 1326 | Galesburg, IL 61402-1326
Telephone: 309-341-1099 | Fax: 309-341-2070 | email
: execsecretary@islma.org
webmaster

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