Private – 2023 ACS Inclusive Pedagogy Institute Registration Form

2023 IPI Registration Form

Your Institution *

First Name *

Last Name *

Preferred Name *

Title *

Department/Discipline *

Cell Phone Number (will not be shared)

Email *

Dietary Restrictions (If any)

Emergency Contact Name *

Emergency Contact Cell Phone Number

Housing Information

Will you need accommodation?

No, thank you.

Yes, I’d like to reserve a single dormitory room on the Millsaps campus at no cost.

Yes, and I will arrange my own hotel room in Jackson at my own expense.

What do you hope to gain from this experience?

Please note that invoices for this event will be sent to your institution after May 1st, 2023. Cancellations must be received in writing by June 19, 2023 at workshops@acsouth.edu in order for your institution to receive a refund.

Housing Information

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