2012 Conference Registration
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Attendee Information
Enter Member Number
Prefix
First Name
Middle Name
Last Name
Suffix
Address 1
Address 2
City/State/Zip ,
Country
Home Phone
Work Phone
Email Address
Work Setting
Current Job/Position:
First Time Attendee
Previous Conferences Attended
Vegetarian
Special Needs?   If yes, please explain.
Badge Information
Name
Name of School/Institution
School City
School State
Pre-Conference Workshops (Saturday, June 23)
  Full Day
(9-4)
  $70.00 
Half Day AM
(9-12)
$35.00 
Half Day PM
(1-4)
$35.00 
AM Featured Speaker $50.00  Andre Norman : 9:00 am - 12:00 pm
PM Featured Speaker $50.00  Dr. Robin Gurwitch: 1:00 pm - 4:00 pm
Conference Registration Rates
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Non Members   $495.00  
Presenters   $275.00  
Principals   $250.00  
One Day 6/23   $175.00  
One Day 6/24   $175.00  
One Day 6/25   $175.00  
One Day 6/26   $175.00  
Registrant Options
Opening Reception - $0 For Attendees
  I wish to attend the opening reception.    
I do NOT wish to attend the opening reception.    
Recognition Dinner - $75 For Attendees
I wish to attend Recognition Dinner.  
I do NOT wish to attend Recognition Dinner.    
Guest Registration
Guest registration is $175. It includes access to the exhibit hall, opening reception, and lunch in the exhibit hall on Sunday and Monday.
  Name of Guest 1
  Name of Guest 2
  Name of Guest 3
  Name of Guest 4
  Name of Guest 5
Additional Guest Tickets
Opening Reception - $30.00 Qty Total $
Recognition Dinner - $75.00 Qty Total $
Payment Type
District Credit Card Personal Credit Card