KYMATYC 2019 Registration Form

KYMATYC 2019 Registration Form

Friday - Saturday, Feb. 22-23, 2019 Boone Tavern, Berea, KY
Full Name

First Name Last Name
E-mail

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

- Area Code Phone Number
College/University
Conference Fees

	Before Feb. 8th	After Feb. 8th
Conference Registration (Includes membership)	$75.00	$85.00
Presenter Registration (Includes Membership)	$20.00	$20.00
Adjunct Registration (No Membership)	$10.00*	$10.00*
Vendor Registration	$300.00	$350.00

*for vendor membership contact kara.cook@kctcs.edu

*Adjunct registration will be refunded at check-in.

Conference Registration Total(Including membership)
Vendor Registration Total
Membership Only Total
Room Reservations
Room Reservations:

I need a room for Thursday night only. I need a room for Friday night only. I need a room for both Thursday and Friday night.
I will be sharing a room with:
I request the following special room accommodations(ADA, Hearing Impaired, other - subject to availabilty)
Scholar Full (1 full bed) (per person, all accommodations are non-smoking):

Single, $85.00 Double, $42.50
Queen (1 queen bed) (per person, all accommodations are non-smoking):

Single, $90.00 Double, $45.00
King (1 king bed) (per person, all accommodations are non-smoking):

Single, $95.00 Double, $47.50
Double Double (2 full beds) (per person, all accommodations are non-smoking):

Single, $95.00 Double, $47.50
Total - room for Thursday Night
Total - room for Friday night
Room reservations received by February 8 are confirmed. Other room types/rates may be available. After Feb. 8, rooms are subject to availability (Please e-mail kara.cook@kctcs.edu for any questions).
Meal Reservations (drinks, tax, and gratuity included in this amount)*
Number of Adult Meals - Friday Dinner Buffet each $32.00
Number of Adult Meals - Saturday Breakfast Buffet each $16.00
Total - All Meals $
Grand Total - Enter total of entire form here.
*Please email Kara.Cook@kctcs.edu with any dietary restrictions.
Please send the grand total by February 8, 2019 to Kara Cook, Bluegrass CTC, 311Q - Classroom Building, 500 Newtown Pike, Lexington, KY 40508. Any exceptions need to be approved via e-mail kara.cook@kctcs.edu. If you wish to pay by credit card, you may do so through the secure PayPal link on the KYMATYC website.

Please keep KYMATYC costs low. Any changes in the registration form or cancellations need to be reported in a timely manner. If you have questions, please e-mail kara.cook@kctcs.edu.
KYMATYC is committed to serving all conference attendees with disabilities and adheres to the guidelines set forth in the Americans with Disabilities Act. Attendees with disabilities requiring special accommodations should contact KYMATYC before February 8, 2019.
Please print a copy of this form for your personal records, especially if you may need a copy for reimbursement purposes at your college or university.
Should be Empty:

KYMATYC 2019 Registration Form

Conference Fees

Room Reservations

Meal Reservations (drinks, tax, and gratuity included in this amount)*