* Required

Member's First PAESSP Conference

First Name:*  

Last Name:*  

Position:

Badge Name (First Name or Nickname):

School District:*  


School District Address Line 1:

School District Address Line 2:

School District City:

School District State:

School District Zip:


School Name:*  

School Address 1:

School Address 2:

School City:

School State:

School Zip:

School Phone:*  

School Fax:

Email:*   


PP ID# or SSN (for Act 48 Credits):


Spouse's Name, if attending:


Choose One Conference Option (Full Conference or Per Diem)

Full Conference Options
All meals and programs are included Member Advance (received before 10/1/08) - $300
Non-Member - $400
Member Attending First PAESSP Conference - $275
Retired Member - $115
Member On-Site Registration (Postmarked after 10/1/08) - $350
Non-Member On-Site Registration (Postmarked after 10/1/08) - $425
Discount Member (3 or more members from same district) - $275*
*To be given the discount rate, registrations must be received together or names of others must be provided here:


Per Diem Options
All meals and programs included unless otherwise indicated.
Sunday - Member - $175
Sunday - Non-Member - $200
Sunday Members Only (w/o Banquet) - $125
Monday - Member - $225
Monday - Non-Member - $250
Monday - Invited Teacher - $125
Tuesday - Member - $125
Tuesday - Non-Member - $150

Extra Meals (for spouse/guest)
Sunday Banquet** - $55
Monday Continental Breakfast - $20
Monday Lunch w/ Exhibits - $30
Tuesday Buffet Breakfast - $30

**Selection for Sunday Banquet - Select number of entree(s) desired:
  Herb Crusted Filet Mignon  
  Salmon Filet w/Teriyaki Sauce  

Meals in which attendee will participate:
Sunday Banquet
Monday Continental Breakfast
Monday Lunch
Tuesday Buffet Breakfast

I will be staying at the hotel (For Hotel Reservations, Click on this link: 2008 PAESSP State Conference)
(Block of rooms held at conference rate until Sept. 18, 2008)

If invoicing is needed, please provide the following information for billing the district:
Purchase Order #:

Purchase Order Date: