A. CONFIRMATION OF PARTICIPATION:

*Your Name (first, middle, last)

*

*Academic Title/Position

*

*Academic Institution/ Affiliation

*

(1) *I understand that I must pay my 2005 Registration Fees and Membership Dues prior to having my paper included in the upcoming IAPL Program.

[Enter "Dues and Registration Paid" with the Date and Means of Payment (Electronic or Regular Mail) in the space to the right.]

*

REGISTRATION FORM WILL BE READY EARLY IN 2005; PLEASE INDICATE ONLY MEMBERSHIP FORM UNTIL THEN.

YOU WILL NEED TO COMPLETE THE REGISTRATION FORM LATER.

(2) *I have already completed the "IAPL Members Interests Form."

[Enter "Interests Form submitted" with date of web submission.]

*

(3) I will need Audio-Visual Equipment for my presentation and have submitted the A-V Form. 

[Enter, if needed, "A-V Form Submitted".] 

B. PROGRAM PLACEMENT 

IMPORTANT: Please note that conference participants can be on the IAPL 2005 Program only once. [This includes all categories except plenary sessions.] 

CHOOSE ONE OF THE FOLLOWING:

 *(1) IF your paper has been accepted for a General Session [GS] or Proposed Session [PS] please enter "GS" or "PS."  

 *(2) IF your paper has been invited or accepted for one of the following, enter "OS"(Organized Session), "IS"(Invited Symposium), "SP"(Special Panel),  "CE" (Close Encounter), or "LW" (Life and Works) . IF you have agreed to serve as a "Session Chair," enter "Session Chair."

GS PS OS IS SP CE LW SESSION CHAIR *

    (a) For papers in a Proposed Session or in one of the second group above, indicate Topic/Title of Session.

    (b) and indicate the name of the Session Organizer.

  (3) IF you have agreed to serve as Session Chair, indicate "Session Chair" followed by "Name of Session."

C. PROGRAM LISTING

(THE FOLLOWING INFORMATION SHOULD BE LISTED EXACTLY AS IT IS TO APPEAR ON THE CONFERENCE PROGRAM.)

1. *Full Paper Title

*

2. *Your Full Name

*

3. *Academic Department

*

4. *University/College/other

*

5. *City

*

6 *State/Province [enter: N/A if not applicable]

*

7. *Country

*

D. CONTACT INFORMATION

1. *E-mail Address

*

2. *Mailing Address (line 1)

*

3.   Mailing Address (line 2)

4. *Mailing Address: City

*

5. *Mailing Address: State/Province [enter: N/A if not applicable]

*

6. *Mailing Address: Postal Code/Zip

*

7. *Mailing Address: Country

*

8.  *Home Telephone

*

9.  *Office Telephone

*

10. Fax