Institute Registration

PERSONAL INFORMATION (One registration form per participant, please.)
Name / Please identify your agencyCountyState Municipal NPS
Title
Agency/Park District
Address
City/State/Zip
Phone / Fax
Email (Confirmation will be sent via email.)

Please complete the form below to register for the 2017 Great Lakes Park Training Institute.

Online registration is also available through our website at

For any questions, please contact us at (812) 855-3095 or .

Please complete this section if you plan on receiving CEUs (Continuing Education Units) during the Institute. You must register for the full conference to be eligible to receive CEUs. CEU verification will be mailed to you after the conference for updating your certification/registration requirements.

CONTINUING EDUCATION CREDITS (CEU) ADDITIONAL INFORMATION
Birthdate / Occupation Code:
00 Other
01 Self-Employed
04 Secretarial/Related Work
05 Sales
06 Business Professions
07 Craftsman/Foreman/Skilled Worker
17 Student
18 Parks and Recreation
Check one please
Male
Female
Instructor Use Only
Amount / Instructor / Date / Receipt #

Fill in your payment information below, please. Registrations before January31,2017, will receive a $15 early bird discount.No refunds will be issued after January 31, 2017. NOTE:Registration does NOT include meals. Registrants staying at the Inn will purchase lodging and meal packages directly from the Inn. Daily registrants will need to arrange for their own meals. The Inn does host a full-service restaurant.

REGISTRATION FEES AND PAYMENT INFORMATION (Please check your selections below.)
Before January31,2017 (Early Bird) / After January31, 2017 / Full-Time Student Rate
Full Institute / $245 / $260 / $80
CEUs / $10 / $10 / N/A
Daily Rate / $95 / $110 / $20
For Daily Registrations, you must indicate the day(s) for which you would like to register. / Mon, Feb 27 Wed, Mar 1
Tues, Feb 28 Thurs, Mar 2
Method of Payment / Check
Make check payable to Great Lakes Park Training Institute. / Purchase Order
Purchase Order Number
______ / All credit card orders must be paid online at