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PASTPRESENT FUTURE

“Paras as an Essential Piece of the Puzzle”

SPEAC 2010

18th Annual Statewide Para Educator Conference REGISTRATION FORM

Friday, October 15th and Saturday, October 16th, 2010

PUEBLO CONVENTION CENTER-Marriott Hotel

320 Central Main Street Pueblo, CO  81003

719-542-1100

Use a separate form for each person: ATTENDEE______ PRESENTER/SPEAKER______

(Please Type or print)

   Phone#

NAME_______________________________________________________ (H) (____________________)

                  Last                                              First                                                                                              

                       (C) (____________________)

Mailing Address______________________________________________________________________________________________________

City_________________________________________________________State_________________________Zip_______________________

Home Email Address_________________________________________School Email Address______________________________________

School Name & Address_______________________________________________________________________District__________________

I need the following accommodations (check all that apply):   Requested ADA Accommodations (by September 15th)

               Dietary meal (by September 15)

CONFERENCE REGISTRATION FEES

____Friday and Saturday….……………………………$99.00 Check /Purchase Order #_______ PAID

ALL INCLUSIVE: Friday night Meet-n-Greet, Continental Breakfast & Lunch (Saturday only)

____Saturday ……………………………………………$79.00 Check/Purchase Order # ________PAID

(Includes Continental Breakfast and Lunch)

I have enclosed my SCHOOL purchase order #___________ in the amount of     $_____________    PAID

*For Financial Assistance check with YOUR district staff development.                                             

SEND REGISTRATION FORM AND PAYMENT TO: SPEAC/Mail to: SPEAC, P.O. Box 60820, Colorado Springs, CO 80906-9998  Deadline for Registration and Payment by September 15, 2010.

Walk-in registrations will be welcome on a space-available basis.   NO LUNCHES WILL BE AVAILABLE FOR PURCHASE ON SITE.  Changes in registrations will add a $30 administrative fee.  NO REFUNDS/Release of purchase orders.  

For questions or information, please e-mail speac@comcast.net and check out our website, SPEAC Website:  www.speac.us

Confirmations will be emailed only if requested! I would like a confirmation emailed to: ______________________________

Weather updates will be given during the conference if necessary.

For Official use only

          Pmt. Rec.’d:_____________   Conf. Sent:______________      By:_______________________________________________

                                                                                                                                                                    Brenda McKinney/Treasurer

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