2016 CCAE State Conference Registration Form

CCAE
CONTACT INFORMATION









Email address REQUIRED!




TITLES AND AFFILIATIONS

FULL REGISTRATION OPTIONS
Full registration includes all keynotes, concurrent sessions, exhibits, President's Reception, Friday Awards Lunch (* note menu selection), Saturday Awards Breakfast, networking and more! Celebrate on the Dock of the Bay not included.

Regular Registration Rate
Quantity (Enter the number 1 if this is your selection)

Presenter Rate
Quantity (enter the number 1 if this is your selection)

LAUSD Registration Rate
Quantity (Enter the number 1 if this is your selection)

Student Registration Rate*
*Student rate applies to adult learners only and should not be misconstrued as applying to individuals seeking a degree in higher education
Quantity (Enter the number 1 if this is your selection)

Non-Member Additional Fee (includes CCAE Membership for the remainder of 2015-2016 AND 2016-2017)
Quantity (enter the number 1 if you are not a member of CCAE)

Attendee-Celebrate on the Dock of the Bay-Friday, April 22, 2016
SOLD OUT!
SOLD OUT!

Guest-Celebrate on the Dock of the Bay-Friday, April 22, 2016
SOLD OUT!
SOLD OUT!

Events-The following events are included in your full registration, please indicate which events you will be attending by checking the box:

SINGLE DAY REGISTRATION OPTIONS

If you will ONLY be attending the Conference for one day, or the Friday Awards Lunch (* note menu selection) and/or Saturday Awards Breakfast or you will be bringing a guest, please check the appropriate box for the daily/event rate:

Friday Only Registration (included Friday workshops, breakfast, and *Friday Awards Lunch)
Quantity (enter the number 1 if this is your selection)


Saturday Only Registration (included Saturday workshops and Saturday Awards Breakfast)
Quantity (enter the number 1 if this is your selection)

Friday Awards Lunch (if not registered for Conference or adding a guest)
Quantity (enter the number of lunch tickets you need)


Saturday Awards Breakfast (if not registered for Conference or adding a guest)
Quantity (enter the number of guest tickets you need)
COUPON CODE

Do you have a coupon code? Enter "1" in the appropriate box and you will receive a full registration. All coupon codes will be verified by the CCAE office. Coupon codes only apply to the price of full registration and can't be applied towards the purchase of events or meals.

CONFCOMP16-$370-Complimentary full registration, enter "1" this box if you are eligible.
Quantity (enter the number 1 if this is your selection)

DOLLGEN16-$370-Full registration, enter "1" in this box if you are a recipient of the Dollar General Scholarship
Quantity (enter the number 1 if this is your selection)
TOTAL FEES

PAYMENT INFORMATION

Fax purchase orders to (866) 941-5129

Mail checks to: CCAE State Conference, PO Box 620, Syracuse, NY 13206

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