ILLINOIS COOPERATIVE COLLECTION MANAGEMENT PROGRAM

ICCMP Membership Meeting – March 1, 2005 Registration Form

Registration Due: February 25, 2005

Please fill in appropriate information and FAX to:   815-753-9395

ICCMP Membership Meeting
March 1, 2005 at the Historic Lincoln Hotel; Urbana, Illinois

Name: ____________________________________________________________________________

Title: ___________________________________________________________________________

Institution: _____________________________________________________________________

Address: _________________________________________________________________________
  ________________________________________________________________________________
  ________________________________________________________________________________

E-mail Address: __________________________________________________________________

Lunch will be provided. Do you have a dietary restriction? Please indicate:
  __________________________________________________________________

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Signature                                                             Date