• Complete this registration form carefully and completely.

  • Please submit your registration only once.

  • If some resulting information is incomplete you will be contacted.

  • Lines marked (*) will be on your badge.

  • Fields shaded in yellow are required fields

  • The badge issued to each registrant is the ticket for admission to all sessions, exhibits and events.

Badge Data:

First Name* Last Name*
Position / Title*   Organization*

Mailing Address (we recommend you use your home address)
Street Address
Address (cont.)
City State/Province CountryZip/Postal Code
Phone
E-mail

Do you need SPECIAL ASSISTANCE due to a disability?

Special Assistance Needed What kind of special assistance do you require? Please be specific.
 

Please Check All That Apply

Teacher Public School Private School  Grade Level Discipline
Government Industry
 

Registration Fees (A selection is required)
Partner or Spouse attending with you? There will be an additional $40 fee
          Partner/Spouse Name:
 Group Rate Discount - subtract $10
 If Group Rate* Discount is selected please enter Group Name:
*3 or more registrations from the same district or company required
  Additional  Items Select Number Required
(include Partner/Spouse)		 Select number & type of Dinner(s)

 

# Attending the Friday Night Banquet with Conference Registration

 X $10 Requires Registration # of Steak Dinners
 

# Attending the Friday banquet ONLY Without Conference Registration

X $40 Not Attending Conference

 # of Vegetarian Dinners

 

Register for the GIS Thursday Workshop 12:30 - 3p

 X $90  
Double check your information before clicking "Submit".
"FRIDAY NIGHT BANQUET WITH CONFERENCE" REQUIRES A CONFERENCE REGISTRATION TO BE SELECTED.
If you have to come back to make a correction after submitting, this form will be sent twice.

After you click "Submit Form" below you will be taken to a Confirmation Page. PRINT THAT PAGE. It contains information about your payment options.