Bebe Feuerstein Simon Early Childhood Institute 2018

Page 1

Please include information for EACH participant attending from your school. Information provided will be used for Badges & Check-in. If you are registering as an individual educator, you only need to fill in the information for yourself.

Participant Information

Title:

First Name:

Last Name:

School:

If your school is not on the drop down list, please write it here:

Position at School:

Phone Number:

Email Address:

You may order lunch for $12 and can request a tuna, turkey or vegetarian sandwich (dietary laws observed). Please use the worksheet on page 2 to finalize make your order.

Will you be ordering lunch?

yes

If so, make your lunch choice here:

Tuna

Vegetarian

Turkey

First Choice- Workshop Session 1 (10:00 am - 11:10 am)

Second Choice- Workshop Session 1 (10:00 am - 11:10 am)

Third Choice- Workshop Session 1 (10:00 am - 11:10 am)

First Choice- Workshop Session 2 (11:20 am - 12:30 pm)

Second Choice- Workshop Session 2 (11:20 am - 12:30 pm)

Third Choice- Workshop Session 2 (11:20 am - 12:30 pm)

First Choice - Workshop Session 3 (1:10 pm - 2:15 pm)

Second Choice - Workshop Session 3 (1:10 pm - 2:15 pm)

Third Choice - Workshop Session 3 (1:10 pm - 2:15 pm)

Total numbers of attendees:

Please go to the next page to calculate fees.

Page 2- Payment Information and Worksheet

The fee structure is as follows:

AFFILIATED SCHOOLS

Early Bird Registration (before February 19)- from 1 to 10 participants- $55/each

from 11 to 20 participants- $50/each

21 or more participants- $45/each

After February 19, the registration fee for affiliated schools increases to $100/each

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NON-AFFILIATED SCHOOLS

Early Bird Registration (before February 19) $80/each

After February 19 $125/each

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Payment Worksheet

Please select the type of registration you are paying for

How many participants are you registering?

Subtotal- payment for registrations $

How many lunches did you order? (You will be charged $12 per lunch)

Total payment due (registrations + lunches ordered) $

Please pay the amount above via PayPal using the button provided below.

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