PRTESOL Central Chapter Conference

Saturday, September 29, 2012

Igniting the Passion for Teaching: Inspiring the Desire for Learning
7:30 am to 3:30 pm

Thomas Alva Edison School, Caguas, Puerto Rico

maysonetvi@gmail.com prtesol-centralchapter.blogspot.com

PRE REGISTRATION FORM

(Please read and print clearly.) Last Names: _______________________________________ First Name: _______________________ Mailing Address: _______________________________________________________________________ City: _____________________ State/Country: __________________________ Zip Code: ____________ Phone: Home/Cell _________________________________ Work _______________________________ Fax: _______________________ Type of institution in which you work: _____ Public _____ Private Level: ______ Pre- School ______ Elementary ______Secondary ______ Higher Education ______ Administration ______Other (please specify) __________

Mailing Address:
PRTESOL Central Chapter P.O. Box 5279

CONFERENCE FEES
Check the appropriate option.

Caguas, PR 00726-5279

Early bird Rate On site Registration (until September 15, 2012) (Cash only) ** Non Member $25 $30 Member $10 $15 *Student member $5 $10 *Student non member $10 $15 **Breakfast and lunch cannot be guaranteed to participants who register on site.

*Please note: Rate applies for full-time students only (nine credits or more) with a copy of class program.

If you are a PRTESOL member, indicate the expiration date of your membership ____/____/______ ID Number: _________________ If you are joining or renewing, fill out a membership form and attach it to this form with a separate check or money order for that amount (payable to PRTESOL). DO NOT INCLUDE MEMBERSHIP FEE TO THIS AMOUNT. Payment Information: Please do not mail cash. Prepare your checks or money orders payable to PRTESOL. TOTAL AMOUNT INCLUDED: ____________________ Money Order Check (Number: ________________ Bank: _________________)
PRTESOL cannot honor requests for refunds during the event. All checks issued returned to PRTESOL due to lack of funds are subject to an additional penalty fee.

FOR OFFICE USE ONLY Date Received _______ Amount $_________ Received by: ______