Printer/fax Friendly Registration Form - Nyscate Annual Conference - 2014

2014   N YSCATE   A nnual   C onference  

Printer/Fax   F riendly   R egistration   F orm  

Fax   t o   5 18-­‐786-­‐3983  

 

 

Registration   I nformation

 

First   N ame   _ ______________________________________________   M I____   L ast   N ame________________________________________________________________________________  

 

 

Nickname   t o   a ppear   o n   B adge_____________________________________________Twitter   U ser   N ame   _ __________________________________________________________  

 

 

Home   A ddress___________________________________________________________City____________________________________   S tate____________   Z ip______________________  

 

 

Home   P hone_____________________________________________________________Employer__________________________________________________________________________  

 

Position   ( Please   c hoose   o ne)  

____Classroom   T eacher   _ ___Technology   I ntegration____   S taff   D eveloper   _ ___   C omputer   R esource   T eacher____Computer   A ssistant    

____Director   o f   T echnology____Building   A dministrator   _ ___District   A dministrator____Computer   C oordinator   _ ___BOCES  

____Independent   C onsultant   _ ___Company   R epresentative____Other:_______________________________________________________________  

 

Work   A ddress____________________________________________________________City____________________________________   S tate____________   Z ip____________  

 

 

Phone____________________________________   F ax   _ _________________________E-­‐mail__________________________________________________________________  

 

____I   d o   n ot   w ish   m y   e -­‐mail   t o   b e   s hared  

 

Checks   a nd   P urchase   O rders   s hould   b e   s ent   t o:  

Org  

Conference   R egistration  

( Does   n ot   i nclude   P re-­‐Con   W orkshop   s essions)  

____Full   C onference-­‐   3   D ays   ( $325   –   a ll   m eals   i ncluded   i n   r egistration)  

____Single   D ay-­‐   S unday   ( $175)  

____Single   D ay-­‐   M onday   ( $175)  

____Single   D ay-­‐   T uesday   ( $175)  

____Presenter   O nly-­‐   F ull   C onference   ( $150)  

Registration   T otal:   _ __________  

 

Pre-­‐Conference   &   H ands-­‐On   S essions  

( In   a ddition   t o   C onference   R egistration)  

____   8   h ours   o f   P re-­‐conference   W orkshops   ( $100)            

 

Workshop   C hoices:_____________________________________________________  

____   6   h ours   o f   P re-­‐conference   W orkshops   ( $75)  

 

Workshop   C hoices:_____________________________________________________  

____   4   h ours   o f   P re-­‐conference   W orkshops   ( $65)  

 

Workshop   C hoices:_____________________________________________________  

____   2   h ours   o f   P re-­‐conference   W orkshops   ( $35)  

 

Workshop   C hoices:_____________________________________________________  

 

____   3   h ours   o f   M icrosoft   P re-­‐Conference   W orkshops   ( $0)  

(Please   c ircle)         S ATAM1         S ATPM6         S UNAM3           S UN   P M4                  

____   M icrosoft   2   D ay   T rain   t he   T rainer   W orkshop   ( $0   –   l imited   t o   t he   f irst   3 0   r egistrants)  

 

 

 

Hands-­‐On   T otal:   _ ____________  

 

Meals  

-­‐   N ew   f or   2 014   -­‐   A ll   M eals   a re   i ncluded   i n   c onference   p ricing  

In   o rder   t o   e nsure   a ccurate   f ood   p reparation,   p lease   s elect   t he   m eals   y ou   p lan   o n   a ttending:  

 

____     S unday   B anquet     _ ___     M onday   B reakfast       _ ____     M onday   L unch     _ ___     T uesday   B reakfast       _ ____     T uesday   L unch  

 

Upgrade   t o   P remium   M embership   ( $50):   _ _______________      

* Includes   V IP   s eating   f or   a ll   k eynotes   a nd   o ther   b

enefits.  

 

Total   ( Include   H ands-­‐On,   C onference,   M embership)        

G rand   T otal:   _

___________________  

 

Payment   I nformation  

Check   # __________   P urchase   O rder   #   _ _____________  

 

Credit   C ard   # ________________________________________________Exp.   D ate___________         N ame   o n   C redit   C ard   _ ______________________________________________