Effective Schools Conference Registration Form

Printable Registration Form

7th Annual
West Coast Effective Schools Conference
June 21st, 2010

Registration Fee: $165

Please print out this form and fax to 888.756.7628
Registrant
First Name:
Last Name:
Position:
Organization:
Address:
City/State/Zip:
Daytime Phone:
Fax:
Email (required):


Payment Method	Make Check or purchase order payable to A+ Educators. Payment must be in U.S. funds.


Check Enclosed	Purchase Order Enclosed	Credit Card:	Visa	MasterCard	Discover/Novus	AMEX

Card Number:		We welcome and recommend substitutions for those who must cancel. Note: All cancellations and substitutions must be in writing and dated. If you need to send a substitute, please send your request to A+ Educators West Coast Effective Schools Conference and fax all correspondence to 888.756.7625.
Expiration:
Cardholder Name:
Cardholder Signature:

Thank you for participating in A+ Educators Effective Schools Conference. A+ Educators may record your contribution or participation in the Conference in photographs or on videotape or audiotape for the purpose of expanding knowledge of the content of the conference (the "Material"). By registering for this event you release all rights or interests in the use of the Material.

7227 North 16th Street, Suite 190 | Phoenix, AZ 85020
P: 866.626.7556 | F: 888.756.7628