BTN 26th Annual Conference “Theatre by Design” Atlanta, GA. July 27-30, 2012
Registration Form
First Name:___________________________ Last Name_____________________________________
Address:_____________________________________________________________________________
City: _____________________________________ State: _______ Zip Code: _____________________
E-Mail: ______________________________________________________________________________
Affiliation: (Institution/Company:_________________________________________________________
____________________________________________________________________________________
Please select your conference registration type:
| Membership Type | Description | Select | |
| Individual Conference Registration Combo - $190 | Conference registration plus membership package. Attend all events at the conference with voting previleges plus one year BTN Individual Membership. | _____ | |
Individual Conference Registration Only - $150 | Conference registration for one individual. Attend all events at the conference without voting previleges | ____ | |
| Organizational Conference Registration Combo - $225 | Conference registration plus membership package. Attend all events at the conference with voting privileges plus one year BTN Organizational Membership. | _____ | |
Organizational Conference Registration Combo - $150 | Conference registration for two individuals of the same organization. Attend all events at the conference without voting privileges. | _____ | |
| Retired Professional Conference Registration Combo - $175 | Conference registration plus membership package. Attend all events at the conference with voting privileges plus one year BTN Retired Membership.Conference: $150 + Membership $25 = $175 | _____ | |
Retired Professional Conference Registration Only - $150 | Attend all events at the conference without voting privileges | _____ | |
| Student Conference Registration Combo- $175 | Conference registration plus membership package. Attend all events at the conference with voting privileges plus one year BTN Retired Membership. Conference: $150 + Membership $25 = $175 | _____ | |
Student | Attend all events at the conference without voting privileges | _____ | |
Super Saver | One advisor and 4 students from the same institution may attend all events at the conference without voting privileges | _____ |
Amount enclosed: $ _______________ - (Make checks payable to Black Theatre Network)
Please complete the registration form and mail with check before April 16 to:
Renee Charlow, Business Manager
Black Theatre Network
8306 Bluebird Way #5
Lorton, Virginia 22079
