printable form

"Achieving Credentials for Success"

GED/HSED & Adult Literacy Conferences

ALONG WITH GEDO 2 SCHOOL STAFF WORKSHOP

STAR Training


October 12-14, 2010 at The Radisson Paper Valley Hotel, Appleton

Online Registration Form-Deadline is September 20, 2010

 

First Name *   MI    Last Name *

 

Employer *

 

Billing Address *

 

City *   State *   Zip Code *

 

Phone *   Ext.

 

Email *

                                 
Selection/Payment*

Registration fee includes continental breakfasts, lunches, breaks and registration materials.

*

*Choose One:  Check   Purchase Order

Check# or PO#* *

*if PO # is not available please enter “to follow” 

 

 

Conference Attendance Accessibility/Special Needs: If you need disability-related accommodations or have special dietary requests while in attendance at the conference, please identify below:

. 

By submitting this form you are registering for the conference and agreeing to send payment as indicated above immediately. Online registrations will be treated the same as mail in and call in registrations.  A $25.00 administrative fee will be charged for any cancellations. No refunds will be issued after Tuesday, September 21, 2010.

Registrations at the conference will be taken if there is space available; however, there will be a $50.00 additional fee.

 

NOTE: All fields with an * following them must be filled in.