| 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): |
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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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Principals� Guide to Hiring: Attracting the Best
Registration: 8:30 - 9:00 AM, Program: 9AM-12PM, Lunch 12PM
East - RESCHEDULED FOR MAY 4, 2004
(Carbon-Lehigh Intermediate Unit #21, Schnecksville)
West - RESCHEDULED FOR APRIL 14, 2004
(Admiral Peary Area Vocational Technical School,
Ebensburg)
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East-Member Rate, $100 |
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East-Non-Member Rate, $175 |
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West-Member Rate, $100 |
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West-Non-Member Rate, $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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