2

nd
Biennial Conference 2015, Society of Race, Ethnicity and Religion
Iliff School of Theology, Denver, Colorado
April 17-19, 2015

REGISTRATION FORM:
First Name________________________ Last Name/Surname__________________________________
Institution____________________________________________________________________________
Mailing Address_______________________________________________________________________
City____________________________ State____ Postal Code________ Country___________________
E-mail_________________________________________ Phone________________________________

MEMBERSHIP DUES & REGISTRATION FEES
Please note that the date on which your payment is received determines the rate you are charged.
Dates are noted in parentheses below. *Includes free parking
Payment Rates Membership Dues Registration* Spouse/Partner Non-Member
Regular Rate (before 3/15) $100 $100 $75 $150
Late Rate (3/16-4/25) $100 $125 $75 $175
On Site $100 $150 $75 $200
Student Rate 50% 50% $75 50%
S/Ps Name___________________________S/Ps Institution___________________________________

Check here if you are physically challenged and require special assistance to participate fully. Attach a written description of
your needs.

AMOUNT DUE FORM OF PAYMENT (choose one):
Membership Dues (2015-16) $_____________
Registration $_____________ Card #_____________________________
Spouse/Partner $_____________ Exp. Date (mm/yy)____/____Security Code______
Contribution $_____________
Institutional Sponsorship $_____________ Signature (required)_________________________
Total $_____________ I agree to pay the above amount according to card
issuers agreement.
Students unable to pay can apply for scholarships Note: 5% processing fee for all credit card payments

My check is enclosed made payable to SRER

MAIL FORM TO: OR SCAN FORM & EMAIL TO:
Society of Race, Ethnicity, and Religion TheSRER@gmail.com
c/o Dr. David Nelson
Box 991
Groton, Massachusetts 01450-0991


HOTEL
Holiday Inn Denver-Cherry Creek Rate $82 (includes breakfast and shuttle to Iliff)
455 South Colorado Blvd
Book online or call: 1-888-565-6159 Mention SRER for special rate

LINK:
http://www.holidayinn.com/redirect?path=hd&brandCode=hi&localeCode=en&regionCode=1&hotelCode=DENCB&_PMID=99801505&
GPC=SRE