UMSI 2013 Fall Conference Registration Form



REGISTRATION: $75.00/person Registration includes a light breakfast and lunch.
DISCOUNTS: After five registrations from the same school the 6th registration and beyond will be $50.00
DEADLINE: Monday, September 23, 2013

Names of the first 25 teachers/assistants/administrators to register will be placed in a drawing for a FREE conference registration next year!
Names of the first 25 parents to register will be placed in a separate drawing for a FREE conference registration next year!

* All fields must be filled out.


 


Name


Street Address


City


State


Zipcode


Phone Number


Email Address


School Affiliation


Number of registrations

Please call Sandy Strantz at 317-627-4623 or
email Tara Slagel at taralb_2000@yahoo.com
if you have any questions.