ANNUAL LEADERSHIP CONFERENCE ONLINE REGISTRATION

ACTEA EVENTS

ANNUAL LEADERSHIP CONFERENCE ONLINE REGISTRATION

Name First Last
Title
Organization (School)
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone - (###) - ### ####
Email

For overnight accommodations at the Desmond call 1-800-448-3500.
Our conference group number is 11T01E. The nightly rate for the conference is $118/night. Please bring tax exempt form when registering. Please note that the conference registration fee and meal costs are non-refundable.

ATTENDANCE OPTION
SELECT ONE
(all options include $175.00 Conference Registration fee)
Wednesday, Thursday. Friday
($ 337.00 (Includes 2 breakfasts, 1 lunch, 2 dinners, breaks)) Thursday & Friday
($303.00 (Includes 2 breakfast, 1 lunch, 1 dinner, breaks)) Thursday ONLY
($275.00 (Includes 1 breakfast, 1 lunch, 1 dinner, breaks))

Mail or Fax with your Purchase Order or check by February 29, 2012 to:
ACTEA, PO Box 184
Johnstown, NY 12095
Fax: 518-736-4331
Make all checks or Purchase Orders payable to ACTEA
ACTEA’s federal EIN is 22-3210680