First name:            Last name: 
Address:    
City:             State:  Zip: 
Institution: Discipline: 
Phone:                Fax: 
email:      


Check all that apply:

 I am a Nebraska faculty member or administrator and I would like to request lodging
(fully paid for by NMSI) for the Teacher Prep conference on the evenings of:
      Wednesday, May 27
      Thursday, May 28

 I live at a distance from Lincoln which requires me to arrive on Tuesday, May 26,
and I request lodging subsidy for that evening.

Note: No travel reimbursement will be provided but if you are willing to share
a room you may apply room savings toward travel expenses.

 I will share a room with .

Note: Once we receive your application you will receive confirmation.  You are
responsible for reserving your room at the Cornhusker by May 7.

Note: There is no registration fee for the Teacher Prep Conference.  Meals will
be provided May 27 and May 28.


If you intend to also stay for the Shaping the Future Conference,
please fill out this form for both conferences instead of the separate
registration form for Shaping the Future.

 I would also like to attend the Shaping the Future Conference May 28 - 30.

 I would like to request lodging (fully paid for by NMSI) for the evening of
Friday, May 29.

The following meals will be provided at the STF Conference: dinner May 28,
lunch May 29, and lunch May 30.

 I would like to request that NMSI pay for my registration at the STF Conference.
We encourage you to bring at least three people to attend both conferences from
your institution to save on registration.  List others from your institution you
believe will attend:




 I have special food/lodging/other needs.  Please describe:


 I wish to be contacted about the possibility of offering a presentation during
the Technology Showcase at the Teacher Prep conference.

 I would be willing to participate in presenting an overview of some aspect of our
teacher prep program.