Registration Form - Fill out on-line then print and fax or mail

Institute on Creating Sustainable Environments for ChildrenSM
June 12-13, 2008
Nebraska City, Nebraska

Name:
Organization/School:
Address:
City: State: Zip/Postal:
Phone: Fax:
E-mail:
Do you require any special accommodations?
Payment:
Amount enclosed:
June 12-13 Institute: $299 x =
      _________________________________
Total payable to WHLLG =

Please select one:

Check or money order enclosed payable to "White Hutchinson Leisure & Learning Group" for above amount.

Payment by VISA.

Payment by MasterCard.

(Sorry no AMEX)
Credit Card Number:
CVV: Expiration Date:
Name on Card: Amount Paid: US $
Signature: Date:

Check or money order for $289 for one-hour graduate credit payable to "National Louis University" (sorry, no credit card payments)
Amount enclosed:
  • One-hour graduate credit
 $289 x =
      _________________________________
Total payable to NLU =
I prefer not to have my e-mail shared with other participants.
  1. Registration includes two lunches.
  2. The Institute will be limited to 60 participants on a first-come basis.  Registration is based on date of receipt.
  3. Deadline for registration is May 8, 2008.
  4. Payment must be paid in US dollars via check, money order or credit card with registration or within 30 days of registration for payments coming from institutions, but not later than the registration deadline.  No registrations will be held if payment is not received by the registration deadline.
  5. There is a $50 cancellation fee.  Cancellations will not be refunded after May 8, 2008 registration deadline.

Institute Hotel
The Institute will be held at the Lied Lodge and Conference Center, Nebraska City, Nebraska (www.liedlodge.org).  Lied Lodge is a sustainable hotel affiliated with the Arbor Day Foundation.  In addition to the lodge which has a pool and spa, the grounds include walking trails, fruit orchards, a model naturalized outdoor classroom, and the Treehouse Adventure.  The Treehouse Adventure is one of a kind nature focused experience designated to educate, entertain and inspire appreciation for trees and the outdoor world.

The Lied Lodge special rate for this Institute is $89 per night for singles and $99 per night for doubles.  Reservations should be made as soon as possible by calling 800-546-5433 and identifying yourself as a member of the White Hutchinson Institute.  Shuttle service is available for a fee from the hotel from and to the Omaha airport.  Plan to stay for the weekend and enjoy the beauty of the Arbor Day Farm and surrounding Lincoln/Omaha area which has many family focused leisure attractions.

Send your completed registration form and payment to:

White Hutchinson Leisure & Learning Group, Inc.
4036 Baltimore Avenue
Kansas City, MO 64111

Credit card registrations should be faxed to 816.756-5058
(no phone in registrations accepted)

If you have any questions, contact Vicki Stoecklin at:
Phone: 816.931-1040, Ext 102 (Central Daylight Time zone),
Fax: 816.756-5058, or
E-mail