Online Registration Form

First Name     

Last Name     

Email        

Campus   Alexandria Annandale Loudoun Manassas Medical Education Woodbridge College Staff Extended Learning Institute Other   

Discipline  

Type of Faculty   Administrative Faculty includes administrators who don’t teach. Professional Faculty includes 12-month counselors, librarians and ELI instructional designers. Teaching Faculty includes 9-month and adjunct/part-time faculty, program heads, and assistant deans. Classified Staff includes staff who provide integral support for teaching and learning. Dual Enrollment Other – please describe your affiliation (e.g., non-profit agencies, consultants)

 Other, Please Specify:  

Dates Expected to Attend and Receive Lunch  (Lunch will not be provided unless indicated.)
In these tight economic times, it is essential that we have an accurate count for the number of meals that we order. Be sure to check the appropriate boxes so we can order your lunch! If you don’t, you will not receive one.

Special Needs and Accommodations

For interpreter services, contact Joan Ehrlich: jehrlich@nvcc.edu.

I Will Receive My Program via:
PUP is committed to a sustainable conference that reduces, reuses and recycles! A large amount of paper is used in the printing of the Conference Programs and one way to reduce the paper use is to print fewer programs, and provide you with others ways to obtain the program that do not use paper. Please indicate how you would like to receive yours:
  Select I will use an App for my digital device I will use the Event Planner and just print my personal schedule I will get what I need from the pdf on the PUP web site Printed program at conference I will use the full printed program as in other years. I won’t use any of these, but will use information available at the conference

Watch for information about the Event Planner and the Apps! They will be ready soon.