Registration Form for NASSPE VII, October 8 and 9, 2011
(Please complete form and PRINT it
out; details below)
Name
Street Address
City, State, ZIP code
Work Phone Number
School or School District (if applicable)
E-mail Address
If using a credit card, please specify Visa, MasterCard or American Express (sorry, we cannot accept Discover)
If using a credit card, please provide credit card number
If using a credit card, please provide exp date and CVV code
If NOT using credit card, please indicate
method of payment (check, purchase order etc.)
Number of attendees (if more than one, please also write the names of other attendees
in this space and/or below)
Registration fee is $400 for one attendee;
$350 per person for 2, 3, or 4 attendees registering together;
and $300 per person for five or more attendees.
Total registration fee
Please print out this form, then either MAIL it to NASSPE at
64 E. Uwchlan Ave., #259, Exton, Pennsylvania
19341-1203; or, you
may fax the form to 610 993 3139.
Questions? Please call NASSPE at 610 296 2821 (ask to speak with Katie) or
send us an e-mail.