PAYMENT INFORMATION
Name on credit card Card #
Expiry Date: /
Early Bird Rate After
Sept. 15		 Student Rate TOTAL
x Conference N/A $350 $250
x Dinner
x Shirt
Total:
TERMS:
1. By clicking SUBMIT you authorize School District No. 73
to charge the amount to your credit card.

2. School District No. 73 reserves the right to void any submitted
registration for any reason including, but not limited to, errors in
total cost calculation as shown above, limits on dinner seating capacity,
or unavailability of conference items (shirts). In the event of such an
occurrence, NO CHARGES will be applied to your credit card.

3. A $35 dollar administration fee will apply to all cancellations
up to and including September 15, 2009. There will be no refunds issued
for cancellations after September 15, 2009.
Organizational Name:
(ex: School District No. 73)
Address:
Postal Code:
City/Prov:
(for receipt)
Email:
(required: Used to confirm registration)
Phone#

How many people from your organization will be attending? Please enter their names and positions. Also please indicate which individuals will be attending the Friday evening dinner banquet and those who are currently students enrolled in a post-secondary educational program for discount eligibility. (Groups of four or more persons get a group discount rate of 10%, students admission discount, and one-size-fits-all conference shirts are optionally available.)
# NAME
(ex: Jay Smith)		 POSITION
(ex: Teacher)		 DINNER
($35)		 SHIRT
($35)		 STUDENT
(discount)
1
2
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4
5
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