Montana Faculty Development Conference

Dates: Friday, April 4 - Sunday, April 6, 2025
Registration Fee: $250

Registration Information

Registrant Name:

Name Preference for Name Tag:

Title:

Specialty:

Organization:

Which of the following meetings will you be attending?

The Faculty Development Weekend (Friday evening – Sunday morning)?

Yes No

The TRUST/WRITE Faculty Forum - specific to TRUST/WRITE faculty and administrators (Friday morning)

Yes No

The MT WWAMI Faculty Retreat (Friday afternoon)?

Yes No

Home State

Which program are you affiliated with?

If "Other," please specify what organization you are with

Address

City

State

Zip

Phone

Billing information same as above?

Yes No

Do you give your permission for us to share your contact information with other conference attendees and speakers of this conference?

Yes No

For Internal Use Only (please Do Not check this box)

Meals

Please enter total number of people who plan to attend each meal, including registrant and guests. Guests will be charged for the Saturday evening banquet meal. Attendee meals at conference are included in registration.

Friday Reception
# attending (including you & number of guests) – No Charge

Number of Friday Attendees

Saturday Evening Banquet
# attending (including you & number of guests) – $40 charge is for guests 13 and up, $25 for children age 3-12.

Number of Saturday Attendees 13 years and older

# of children attending

Breakfast (includes both Saturday and Sunday Morning)
# attending (including you & number of guests) – $30 charge is for guests only

Number of Breakfast Attendees

Dietary restrictions?

Total Registration

$

Please verify that you are human to proceed

For questions about or problems with registration, please contact:

Rachel Norris
Montana AHEC /
Montana Office of Rural Health

Tel: 406-994-6495
Email: rachel.norris@montana.edu