2004 PAESSP Conference Registration
Personal Information
Name:
I am a member of PAESSP:
Preferred Name
on badge:
Job Title:
SS#:
(For Act 48 Credits)
Home Address:
(For Act 48 Credits)
Home City:
Home State:
Zip Code:
E-Mail:
Spouse's Name
if attending:
Spouse need not pay registration fee - only fee for meals attending
Check if this is your first time
at a PAESSP conference
Check if you are staying
at the Sheraton Station Square Hotel
For reservations call the Sheraton at 412-261-2000
School Information
School:
District:
School Address:
City:
State:
Zip Code:
School Phone:
(
)
School Fax:
(
)
Conference Details
Full Conference
NOTE: Member On-Site Registration - $300 (Postmarked after 10/08/04)
Member Advance
$250
Member Advance Discount Rate*
$225
*Three or more full conference registrations from same district - fee reduced to $225 per person (must be received together).
Please enter additional district attendants (for discount rate):
Non-member
$350
Retired Member
$130
Passport
PASCD/PAESSP Passport
$60
(with full conference registration only - attend PASCD's Monday sessions for an additional $60.
See terms
)
Per Diem Rates*
NOTE:
DO NOT CHOOSE PER DIEM OPTIONS...
IF YOU HAVE ALREADY SELECTED ONE OF THE FULL CONFERENCE REGISTRATIONS LISTED ABOVE.
*Make sure to check the "I am a PAESSP member" box at the top of the form to receive member rates
Sunday
-
Member $100
/
Non-member $125
(includes all programs of the day plus lunch and presidents' reception)
Monday
-
Member $175
/
Non-member $200
(iincludes all programs of the day plus breakfast, lunch, and banquet
**
)
Members Only - Monday without Banquet
$125
Tuesday
-
Member $75
/
Non-member $100
(includes all programs of the day plus buffet breakfast)
Extra Meals
(for spouse/guest)
Sunday �
Served Lunch -
$25
Monday �
Continental Breakfast -
$15
Box Lunch -
$20
Banquet
**
-
$45
Tuesday �
Buffet Breakfast -
$25
**Monday Banquet Selection
Total Number of Meals:
Orange Roughy
Filet Mignon
Please check all meals you will be participating in:
Sunday Lunch
Monday Breakfast
Monday Lunch
Monday Banquet
Tuesday Breakfast
Billing
P.O.# for district billing
Date:
Full District Address: