* 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#:*  


Spouse's Name, if attending:

(Spouse need not pay regis. fee - only cost of meals attending.)

Choose One Conference Option (Full Conference or Per Diem)

Full Conference Options
All meals and programs are included Member Advance - $300
Non-Member - $400
Member Attending First PAESSP Conference - $275
Retired Member - $115
Member On-Site Registration (Postmarked after 9/21/09) - $350
Non-Member On-Site Registration (Postmarked after 9/21/09) - $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:


 I am not registering for a PIL Program, but would like to attend Charlotte Danielson’s session on Sunday from 9:10 - 10:10 a.m. Conducting Professional Conversations at no cost.

Per Diem Options
All meals and programs included unless otherwise indicated.
Sunday - Member - $175
      (includes all p.m. sessions plus refreshments, president’s reception and banquet*)
Sunday - Non-Member - $200
      (includes all p.m. sessions plus refreshments, president’s reception and banquet*)
Sunday Members Only (w/o Banquet) - $125
      (includes all p.m. sessions plus refreshments)
Monday - Member - $225
      (includes all programs of the day plus continental breakfast, lunch and refreshments)
Monday - Non-Member - $250
      (includes all programs of the day plus continental breakfast, lunch and refreshments)
Monday - Invited Teacher - $125
      (includes all programs of the day plus continental breakfast, lunch and refreshments)
Tuesday - Member - $125
      (includes all programs of the day plus buffet breakfast)
Tuesday - Non-Member - $150
      (includes all programs of the day plus buffet breakfast)

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

**Selection for Sunday Banquet - Select number of entree(s) desired:
  Filet Mignon  
  Crab Cakes w/Remoulade Sauce  

Extra Meals (for spouse/guest)
Extra Sunday Banquet** - $50
Extra Monday Lunch - $20
Extra Tuesday Buffet - $20


I will be staying at the hotel

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

Purchase Order Date: