January Workshop Registration Form

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Wednesday, January 30, 2008

Augusta Civic Center - Augusta, Maine

Registration Fees: A--MADSEC Members and Staff from Member Units
Early Bird: $119            After 1-09-08: $139
  B--Non-Members
Early Bird: $139            After 1-09-08: $159
Name of Director
(Needed for staff in "Member" Category):
School Unit:
Charge to:
Purchase Order Number:
Address #1:
Address #2:
City: State: Zip:
 

Name of Registrant #1:
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E-mail Address:
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If registrant(s) needs any special accomodation(s) to make it possible to attend this workshop (e.g. disability or dietary needs), please describe in the following comment box. Thank You