1. REGISTRATION FORM
ASTD Member I.D. Number: __________________________________________________________ Chapter Code (if applicable): _____________________________________
o Mr. o Ms. o Mrs. o Miss Enterprise Partner Code (if applicable): _____________________________
Last Name: ______________________________________________________________________ First Name: _________________________________________________
Title: _________________________________________________________________ _______________________________________________________________________
Organization: _____________________________________________________________ ____________________________________________________________________
Address: _______________________________________________________________ _______________________________________________________________________
City/State/Province: _______________________________________________________________ Country/Zip/Postal Code: ______________________________________
Business Phone: __________________________________________________________________ Fax Number: ________________________________________________
Email Address: ___________________________________________________________________
Preferred Name for Badge: __________________________________________________________
ASTD MEMBERSHIP
Join ASTD now and save on conference registration fees. Learn more about ASTD at www.astd.org/membership. If you have a disability that requires auxiliary
aids during the conference, please specify.
Select Your Membership Type o Renew o New
o Audio o Mobile o Visual
ASTD 1-Year Membership (Includes print copies of T+D)
U.S. Only o $199
Canada & Mexico only o $224
Outside North America o $269 ASTD shares only your mailing information
ASTD 1-Year E-Membership with our sponsors and exhibitors.
Outside U.S. only o $169
o I do not want to receive communications
Student Membership from ASTD TechKnowlege® 2012 sponsors
Must be enrolled full-time at an accredited institution OR maintain an active or exhibitors before, during, and after,
ASTD chapter membership. Students outside the U.S. receive e-memberships o $59 the event.
Senior Membership
Ages 62+. Seniors outside the U.S. receive e-memberships. o $90
CONFERENCE REGISTRATION OPTIONS
Full Conference Badge
A FULL conference registration includes concurrent sessions, and general sessions from January 25-27 and entrance to EXPO Hall from January 25-26.
Member Nonmember
o Early-Bird Rate (postmarked or dated by November 28) o $850 o $1,150
o Advanced Rate (postmarked or dated by January 4) o $950 o $1,250
o Regular/Onsite Rate (January 5 through January 27) o $1,100 o $1,400
o Conference Team Rate o $800 o $1,100
Conference Team code: _____________________
For more information on corporate teams, or to obtain your code, contact conferenceteams@astd.org.
o International Delegation Rate o $800 o $1,100
International Delegation code: _____________________
For more information on international delegations, or to obtain your code, contact nwashington@astd.org.
o *Student Rate o $350 o $450
Daily Badge
A DAILY conference registration includes concurrent sessions, general sessions, and entrance to EXPO Hall for the particular day(s) specified.
Member Nonmember
o Daily Rate - Please specify day(s) - includes access to EXPO o $350/day o $450/day
o Wednesday o Thursday o Friday (no EXPO)
EXPO Only Badge
An EXPO ONLY registration allows entrance to the EXPO Hall for the particular day(s) specified.
Member Nonmember
o Please specify which day(s): o $25/day o $25/day
o Wednesday o Thursday

2. Last Name: First Name: ASTD Member I.D. Number (if applicable):
PRECONFERENCE WORKSHOPS AND CERTIFICATE PROGRAMS
Events
Full-day Preconference Workshops – January 24, 2012 (9:00 a.m. - 5:00 p.m.) Member Nonmember
o Workshop 1 - Creating Scenarios and Story Interactions Using Articulate StoryLine ®
o $405 o $505
o Workshop 2 - Prototyping for Mobile on a Shoestring Budget with Virtually No Tech Skills! o $405 o $505
o Workshop 3 - Lights! Camera! Training! How to Create Video for Training o $405 o $505
o Workshop 4 - Photoshop: From introduction to fixing and preparing digital images o $405 o $505
Half-day Preconference Workshops – January 24, 2012 Member Nonmember
o Workshop 5 - ISD for the Synchronous Environment (8:30 a.m. - 12:00 p.m.) o $200 o $300
o Workshop 6 - Making E-Learning Stick: Techniques To Increase Transfer of Training (1:00 p.m. - 4:30 p.m.) o $200 o $300
o Workshop 7 - Hands-on with A Variety of Technology Based Learning Tools (8:30 a.m. - 12:00 p.m.) o $200 o $300
o Workshop 8 - Introducing a Social Learning System for Formal and Informal Learning (1:00 p.m. - 4:30 p.m.) o $200 o $300
o Workshop 9 - Video Editing for Trainers (1:00 p.m. - 5:00 p.m.) o $200 o $300
Certificate Programs – January 22 – January 24, 2012 (8:30 a.m. - 4:30 p.m.) Member Nonmember
Designing Learning Certificate (DLLV0112) o $1,495 o $1,795
Measuring and Evaluating Learning Certificate (MELLV0112) o $1,495 o $1,795
Training Certificate (TCLV0112) o $1,395 o $1,695
Certificate Programs – January 23 – January 24, 2012 (8:30 a.m. - 4:30 p.m.) Member Nonmember
Advanced E-learning Instructional Design Certificate (AELLV0112) o $1,295 o $1,595
Blended Learning Certificate (BLLV0112) o $1,295 o $1,595
Consulting Skills for Trainers Certificate (CSTLV0112) o $1,095 o $1,395
CPLP Study Prep Workshop (PRELV0112) o $995 o $1,295
E-learning Instructional Design Certificate (ELLV0112) o $1,095 o $1,395
Managing Organizational Knowledge Certificate (MOKLV0112) o $1,095 o $1,395
Multimedia for Instructional Designers Certificate Program (MIDLV0112) o $1,295 o $1,595
Project Management for Learning Professionals (PMLV0112) o $1,095 o $1,395
PAYMENT INFORMATION
5
Total Fee: _______________ Easy Way to Register!
Please check method of payment: online: www.tk12.astd.org
o VISA o MasterCard o Discover o American Express
fax: 1.703.299.8723
phone: 1.800.628.2783 or
Card Number Expiration Date 1.703.683.8100
mail: American Society for
Signature Today’s Date Training & Development
P.O. Box 1567
Merrifield, VA U.S.A.
o Purchase order number – A signed P.O. must accompany this form on company letterhead.
22116-1567
o Check Enclosed – Please make checks payable to ASTD in U.S. dollars. Registration cannot be processed if check is not enclosed.
wire transfer: Please call 1.703.683.8100
o Wire transfer – Registration cannot be processed until wire is received. Call Customer Care for wire transfer info.
for complete instructions
111119.45410
Badge Credentials will be mailed to attendees who have registered before December 13, 2011. There will be no refunds issued after December 13, 2011. All cancellations prior to December 13,
2011 are required in writing and a $50 cancellation fee will apply. Online and pre-registration ends at 6:00 p.m. EST on January 17, 2012. After this time, attendees will need to register onsite.
Visit www.astd.org/cancellation for complete terms and conditions. All credits issued must be used within a year. *12 credit hours per year required to be eligible for student rate.