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ATTENDEE REGISTRATION FORM
Fill out and
FAX
Fill out and
FAX
with Credit Card Information
For PDF version click
here
Organization Name: ___________________________________________
Mailing Address: ______________________________________________
City: __________________________ State: _______
Zip: _____________
Attendee Name: _______________________________________________
Attendee Title: ________________________________________________
Phone: _______________ Fax: _______________ Email:
_______________
If Group Registration, Names & Titles of Other Attendees: (use
3rd sheet for more)
1. ____________________________________________________________
2. ____________________________________________________________
3. __________________________ _________________________________
CONFERENCE AND WORKSHOP REGISTRATION
FEES
Conference and Workshop
Registration Fees include breakfast, lunch and refreshments
If you are not
currently a member of CCSA, please go to the CCSA
Website and click on "Join the Association" - and then come back and sign up for
the conference and receive the member discount!
Please Check All That Apply Below:
| |
EARLY BIRD
If Payment Received Before
February 15th |
If Payment Received Between February
15th &
March 10th |
LATE FEE
If payment received
after March 10th |
Three (3) or More
From Same Organization |
|
CCSA Members |
$290 |
$325 |
$380 |
$290 per person
(no early discount) |
| Non-Members |
$355 |
$395 |
$450 |
$355 per person
(no early discount) |
| Attend One Day |
$150
Mon/Tues
$75 Wed
|
$150
Mon/Tues
$75 Wed |
$150
Mon/Tues
$75 Wed |
N/A |
| Pre-Conference
Teacher
Day |
$135 |
$150 |
$165 |
$135 per person
(no early discount) |
Full
Conference
Teacher Discount |
$245 |
$245 |
$245 |
$245 |
TOTAL AMOUNT FOR THIS
REGISTRATION FORM: $
______________________
Space for the Awards Dinner is
limited. You need to be registered for the conference to
attend. Reservations will be held on a first come, first serve
basis.
I would like to attend the Awards Dinner on Tuesday March 30, 2004 from
7pm – 9pm YES NO How many people?
__________
I would like to Reserve a Meeting Space for a 90 minute timeslot
CANCELLATION POLICY
Cancellations
must be in writing and received before the following cancellation
deadlines:
- On or before February 1, 2004 –
80% refund
- After February 1 but before March 10
– 20% refund
- After March 10 – No refund
Cancellation requests must be sent to:
California Charter Schools Association – 2004 Annual Conference
Conference Management
1277 University of Oregon
Eugene, OR 97403-1277
QUESTIONS?
If you have any questions about
registration, please contact the registration office at
1-800-280-6218 or 1-541-346-3537 (M-F, 8am - 5pm, PST).
METHOD OF PAYMENT
By Credit Card (Fax Application) Credit Card: Visa MasterCard
Credit Card Number: ____________________________________
Expiration Date: ____ / _______
Authorized Signature: ___________________________________
Complete and sign Application Form and Fax to:
1-541-346-3545
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