2016 Conference Registration – Region 6 May 11-13, 2016, Omaha, NE

Check the registration fee that applies

NACADA FEIN number: 48-1114759

PAYMENT INFORMATION- pay in U.S. Dollars on an U.S. Bank - Thank You

For Office Use Only Initials

Date

Ck #/Amount

Deposit #

Notes:

Registrant Information

Last Name: First Name: MI:

Nickname: Job Title:

Institution:

E-Mail:

Address: City:

State: Country:

County:

List Vegetarian, Vegan or Severe food allergy:

List ADA physical accessibility need:

Emergency Phone:

I would like to Volunteer This is the 1st NACADA event I have attended

Business Phone:

Home Phone: Fax:

Zip Code:

Participants with accessibility needs must contact and confirm ADA arrangements by April 11, 2016 with Amy Dillard at adillard@iwcc.edu On or Before

April 11AFTER April 11

Current Member (Does not include membership fee.)

Student / Retiree (Does not include membership fee.)

Non-Member

$130 $165

$100 $100$220 $255

Total Due:

Registration Registration may be made via: Fax: 785-532-7732 Online: www.nacada.ksu.edu Mail: NACADA 2016 Region 6 Conference 2323 Anderson Avenue, Suite 225 Manhattan, KS 66502-2912 On-site: If on-site registration is necessary, you will need to call the Executive Office at 785-532-5717 with a credit card # before your registration can be completed. All individuals, including presenters, must register and pay the conference fee. Cancellation and Refund Policy All requests must be in writing and mailed or emailed (nacada@ksu.edu) to NACADA. On or before April 11, 2016: A refund of conference fee, less $25 administrative fee. Between April 12 - May 6, 2016: A 50% refund of conference fee. After May 6, 2016: Due to facility and conference obligations, no refunds are given. -Registrations may be transferred to another individual from your institution. -If the conference in cancelled, registration fees will be returned. Questions & Information Web Site: www.nacada.ksu.edu Email: nacada@ksu.edu Phone: (785) 532-5717 Registration in this meeting authorizes NACADA to include you in event photos to be shared with the group or in promotional materials in the future. If you wish to opt out of these photos, please email your request to nacada@ksu.edu.

Pre-Conference Workshops

Want Member Discounts? If you register as a Non-Member, you acknowledge no reimbursement for lost discounts will be made, even if membership status changes. To receive Member Discounts! 1. Attach membership form WITH PAYMENT to this registration

OR 2. Join on-line at www.nacada.ksu.edu

P1. 1:00 - 3:30 Best for Vets, an Office of Military and Veteran Services

P3. 3:30 - 4:00 First Time Attendee Orientation

$25

$0$0

$25

I certify that I will secure payment for the total amount due

Method of Payment (choose one):

Check (payable to NACADA): # Returned check fee is $35

Agency Purchase Order (PO): # A PO MUST be attached.

Credit Card (choose one): Visa Master Card American Express Discover

Card number:

Expiration Date: Name on card (print):

Cardholder Signature Required:

CVV Number:

P2. 1:00 - 3:30 Proactive Advising: Relationship Building for Students of Color $25$25

MEMBERSHIP INFORMATION R-6

Last Name First Name M.I.

Institution

Method of Payment (choose one):

Check (payable to NACADA): # Returned check fee is $35

Credit Card (choose one): Visa Master Card American Express Discover

Signature for Credit Card below:

Email:

To join or renew membership at this time (& receive member discounts) you may: Apply on-line for immediate confirmation of your membership status at www.nacada.ksu.edu, OR Attach this form WITH CHECK (mail) OR CREDIT Card (fax or call).

Payment must accompany this form.

NACADA FEIN number: 48-1114759

For Office Use Only Initials

Date

Ck #/Amount

Deposit #

Notes:

$65 General Member (Employed by an accredited institution)

$85 Associate Member (Not employed by an accredited institution)

$20 Student Member $150 Institutional Member

Expiration Date: Name on card (print):

Card number: CVV Number:

ROLE DEMOGRAPHIC INFORMATION Ethnic Background Gender

Birth Year:

YEARS ADVISING < 3 years 3-5 years 6-10 years 11-15 years

Faculty Advisor Academic AdvisorAcademic CounselorAdvising AdministratorLicensed CounselorNon-Institutional

Amerindian/First NationsAsianBlack (non-Hispanic)Latino/HispanicMulti-ethnic

Other

FemaleMaleTransgender

Periodically NACADA distributes mailing lists to other educational entities. To be excluded, check box.

> 15 years

StudentOther

White (non-Hispanic) N/A

Prefer Not To Answer

Prefer Not To AnswerPrefer Not To AnswerYou may choose any four (4) of these specific advising areas:

Refer to www.nacada.ksu.edu for further information on Commission and Interest Group membership.

NACADA and Kansas State University are committed to nondiscrimination. Contact the Director of Affirmative Action, KSU, 214 Anderson Hall, Manhattan, KS 66506. NACADA may provide directory information on members. To withhold your information, email a request to nacada@ksu.edu

Administration of Advising

Advising in Academic Programs I

Advising in Academic Programs II

Advising Specific Populations I

Advising Specific Populations III

Institutional Type

Advising Specific Populations II

Theory, Practice and Delivery of Advising I

Join or Renew Your Membership

Theory, Practice and Delivery of Advising II

C= Commission IG= Interest Group PIG = Potential Interest Group

CIG101 Advising Administration (C)CIG102 Advisor Training & Development (C)CIG103 Assessment of Advising (C)CIG104 Ethics & Legal Issues in Advising (IG)

CIG201 Advising Business Majors (C)CIG202 Advising Education Majors(C)CIG203 Advising Fine Arts Students (C)CIG204 Advising Graduate & Professional Students (IG)CIG205 Doctoral Students (IG)

CIG301 STEM Advising (C)CIG302 Health Professions Advising (IG)CIG303 Liberal Arts Advisors (C)CIG304 Pre-Law Advising (IG)

CIG401 Advising Adult Learners (C)CIG402 Advising First-Year Students (IG)CIG403 Advising Second-Year Students (IG)CIG404 Advising High Achieving Students (C)CIG405 Advising Student Athletes (C)

CIG501 Advising Students with Disabilities (C)CIG502 Advising Transfer Students (C)CIG503 Advising Veterans, Military Students & Family Members (IG)CIG504 Global Engagement (C)CIG505 First-Generation College Student Advising (IG)

CIG601 High School to College Advising (IG)CIG602 Commission for LGBTQA Advising and Advocacy (C)CIG603 Multicultural Concerns (C)CIG604 Probation/Dismissal/Reinstatement Issues (IG)CIG605 Undecided & Exploratory Students (CUES) (C)

CIG701 Advising at Historically Black Colleges & Universities (IG)CIG702 Canada (IG)CIG703 Large Universities (IG)CIG704 Native American & Tribal College (IG)CIG705 Small Colleges & Universities (C)

CIG901 Career Advising (IG)CIG902 Distance Education Advising (C)CIG903 New Advising Professionals (IG)CIG904 Technology in Advising (C)CIG905 Retention & Persistence (PIG)

CIG706 Two-Year Colleges (C)

CIG801 Advising & Academic Coaching (IG)CIG802 Appreciative Advising (IG)CIG804 Faculty Advising (C)CIG806 Peer Advising & Mentoring (C)CIG808 Theory & Philosophy of Advising (C)