IMC and the Polis, June 6-8, 2013, University of North Carolina Wilmington

1.	First Name*

2.	Last Name*

3.	Preferred Name for Badge*

4.	Institution*

5.	Address 1*

6.	Address 2

7.	Address 3

8.	City*

9.	State

10.	ZIP/Postal Code*

11.	Country

12.	Phone Number*

13.	E-mail Address*

14.	Dietary Restrictions?

15.

Are you interested in any of the Thursday afternoon optional recreational events? These are not included in the $100 registration fee. Check all that apply. The conference planner will follow up with details in April.

	Golf
	Wrightsville Beach
	Historic Downtown Wilmington Tour

The registration fee is $100/person, which includes breakfast and lunch on Friday and Saturday and all three evening events.
Make checks out to "UNCW COM Studies" and put "IMC Conference" in the memo line.

Please mail checks to:

Debbie Whiting
UNCW Department of Communication Studies
Leutze Hall 226
671 Racine Dr. CB#5933
Wilmington, NC 28403

If you have any questions concerning registration, please contact conference planner Jeanne Persuit at imc@uncw.edu or at 910.962.2616.