Institute of Child Nutrition’s CICN Advisory Board Meeting Registration Form

Preferred Name*
First Last
Degree(s)/Credentials
Please add any degree(s) or credentials to appear in the agenda and name tag
Title*
Organization*
Address*
Please enter your same address as it appears on your W-9 form.

Street Address Address Line 2 City State ZIP Code
Email*
Enter Email Confirm Email
Phone*
Mobile Phone*
Travel Information
Please enter the necessary travel arrangement information.
The ICN will book your room at The Inn at Ole Miss and the charges will be covered by the Institute
ICN will reimburse you for the following expenses, with original, itemized receipts:
- Airline Ticket (if you opted to purchase your own)
- Rental Car (according to ICN travel policies and procedures)
- Meals
- Baggage fees
- Airport parking at home airport
- Mileage to and from home to airport
Click here for directions to The Inn at Ole Miss from Memphis Airport.
Click here for directions to the Institute of Child Nutrition from The Inn at Ole Miss.
Note: ICN has specific policies for purchasing your own airline ticket. Please contact your project coordinator, Colin Hughes, with any questions.
Mode of Transportation*
- I will drive to the training
- I will purchase my own airline ticket
- I would like ICN to purchase my airline ticket
- I will not be requesting reimbursement.
Expected Mileage
A driving versus flying comparison must be approved for round trips greater than 500 miles. Please contact your project coordinator prior to travel.
What airport do you depart from?*
You will fly into Memphis International Airport. Please enter your departure airport
Full Name as it appears on ID Card used for airport security*
Date of Birth*
Month
Day
Year
Gender*
- Female
- Male
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Comments
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Institute of Child Nutrition’s CICN Advisory Board Meeting Registration Form

Travel Information

Note: ICN has specific policies for purchasing your own airline ticket. Please contact your project coordinator, Colin Hughes, with any questions.