| Employment Information |
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| Your Name: |
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| Title/Position: |
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| School District: |
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| School Name: |
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| School Address Line: |
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| City: |
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| State: |
Zip Code:
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| Office Phone & Ext: |
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| Office Fax: |
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| Email Address (Required): |
(Required) |
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| Personal Information |
This Information is Required for ACT48 Reporting: |
| Address Line: |
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| City: |
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| State: |
Zip Code:
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| Home Phone: |
(
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| Social Security # |
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| Registration Selection |
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"Legal Issues for Administrators"
Registration 8:30-9:00 am
Program 9:00-12:00 pm
Lunch 12:00 pm
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Ebensburg - April 20, 2005 - (Members $100)
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Monroeville - April 21, 2005 - (Members $100)
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Grantville - April 22, 2005 - (Members $100)
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Schnecksville - April 26, 2005 - (Members $100)
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Phoenixville - April 27, 2005 - (Members $100)
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"Legal Issues for Administrators"
Registration 8:30-9:00 am
Program 9:00-12:00 pm
Lunch 12:00 pm
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Ebensburg - April 20, 2005 - (Non-members $175)
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Monroeville - April 21, 2005 - (Non-members $175)
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Grantville - April 22, 2005 - (Non-members $175)
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Schnecksville - April 26, 2005 - (Non-members $175)
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Phoenixville - April 27, 2005 - (Non-members $175)
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| Lunch |
Do you intend to stay for lunch (included in price)?
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Yes, I plan on staying for lunch. |
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No, I do not plan on staying for lunch. |
| Please Enter Purchase Order Information (If
Already Available) |
P.O. #:
Date:
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