REGISTRATION FORM
Name 
Title  Dept. 
Organization 
Address 
City  State  Zip 
Phone 
Email 
Affiliation: 
 Employer  Academic Professional – 2 year school  Academic Professional – 4 year school
Registration and Membership Fee
 Conference & Membership ($80)  Membership only ($25)  Conference only ($55)
Total:  Invoice Request (Please check here)_____

Please make check payable to ILCEIA
Send registration and payment to:

Tanye Harrison, Associate Director
Engineering Co-op Program
FMCEDC, Rm, 2-350
Northwestern University
2133 Sheridan Road
Evanston, IL 60208-3122
phone 847/491-2613
fax 847/467-4727
t-harrison4@northwestern.edu

IIT Map and Directions (Main Campus):
http://www.iit.edu/about/directions_main.html

Conference questions?
Please contact
ILCEIA Vice President Lovetta Houston
312.567.6484 (Office)
Houston@iit.edu