Puerto

Rico TESOL 40th Annual Convention Friday and Saturday, November 1-2, 2013 Meeting 21st Century Needs: Aligning Curriculum and Teacher Performance. Sheraton Puerto Rico Hotel & Casino, San Juan, PR www.puertoricotesol.org email: info@puertoricotesol.org

PRE-REGISTRATION FORM
(Please read and print clearly) Last Names: Membership ID #: Mailing Address: City: Phone (home): State/Country : Cellular: Email: Name of Institution __________________________________ Zip Expiration date: First Name(s): Chapter:

Type of institution in which you work: Public Private

Other (please specify) ___________________________

Level: Elementary Secondary H igher Education Administration

C o n v e n t i o n F e e s
Please check appropriate option.

Both days with meals

One day with meals

Vegetarian lunch
Pre- registration
Before: Sept 15, 2013

Friday Saturday Vegetarian lunch

Pre- registration
Before: Sept 15, 2013

On Site
Lunch not guaranteed

On Site
Lunch not guaranteed

Use separate form for each registrant. If payment is through a purchase order or institutional check for more than one registrant, please include a separate registration form for each individual: purchase orders must list each attendees name and have an original signature. *Non-member rate includes PRTESOL membership. **Rate applies for full-t ime student only (twelve credits per semester or more) with a copy o f c lass program.

Member *Non-Member **Student or Retired members

$140 $190 $100 $135

$180 $220 $130 $165

$80 $115 $70 $110

$120 $155 $115 $145

**Student or retired Non- Member

Mail Payment & Registration form to: PRTESOL CONVENTION P. O. BOX 366828 SAN JUAN, PR 00936-6828

How did you find out a bout the convention?

Website email facebook twitter PRTESOL Gram or Bulletin poster/flyer colleague/friend Professor
If you are joining o r renewing, fill out a membership form and attach it to this form with a separate check for that amount. DO NOT INCLUDE MEMBERSHIP FEE TO THIS AMOUNT. Payment Information: Please do not mail cash. Prepare your checks o r money o rders payable to PRTESOL.

TOTAL AMOUNT INCLUDED: $

Money Order Check Number: _____________________ Bank:_______________________________
FOR OFFICE USE Date Received _____________ P R T E S O L w i l l n o t h o n o r r e q ue s t s fo r re fu n d s . A l l c h e c k s r e tur n e d to P R T E S O L d u e to l a c k o f fu n d s a r e s u b j e c t to a $ 1 5 p e n a l t y fe e .

Amount $_________ Received by: _____________________