International Thomas Merton Society

Bellarmine University

ITMS Conference Registration Form:

        Name:        __________________________________________________________________

        Address:    __________________________________________________________________

        City:            __________________________State, Zip:   ______________________________

        Phone:         ___________________        Email: ____________________________________

Registration Fees for the conference and all meals:

                □ ITMS Member - $200.00
                □ ITMS Member - $250.00 Late Registration Fees (between May 15 and June 1)

                □ Non-Member - $250.00
                □ Non-Member - $300.00 Late Registration Fees (between May 15 and June 1)
                □ I prefer a vegetarian entrée at the banquet.
 

$_________

Accommodation:
                □ $150.00 (for three nights - per person)

 $_________

Additional Lodging Fee:
                □ Wednesday, June 10 - $50.00 (no meals)
                □ Sunday, June 14 - $50.00 (no meals)

 $_________

Daggy Scholarship Fund:
 Would you like to make a donation to the Daggy Youth Scholars Fund?
 Donations to the Daggy Scholarship Fund are tax deductible to the extent allowed by law.

 $_________

Total
(made payable to ITMS):  

$_________

Please print and return this form, with check or money order made out to ITMS, to:
Christine M. Bochen
Nazareth College
4245 East Avenue
Rochester, NY 14618-3790.