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Personal Information

Member's First PAESSP Conference

* First Name

* Last Name

* Position

* Badge Name (First Name or Nickname)

Spouse or Guest's FIRST and LAST Name, if attending

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

School District Information

* School District

* School District Address (Line 1)

School District Address (Line 2)

* School District City

* School District State

* School District Zip

School Information

* School Name

* School Address (Line 1)

School Address (Line 2)

* School City

* School State

* School Zip

* School Phone (include area code - numbers only)

* School Fax (include area code - numbers only)

* Email

* PP ID #

Choose One Conference Option (Full Conference or Per Diem)

Note: To attend a PIL program, you must register for a full conference option. PIL information will not be displayed until you have selected one of these options.

Full Conference Options

All meals and programs are included

Early Bird Registration (received on/before 7/31/15)

Member Early Bird - $300
Non-Member Early Bird - $400

Registration

Member Advance - $325 (received 8/1/15 - 10/12/15)
Non-Member Advance - $425 (received 8/1/15 - 10/12/15)
Member Attending First PAESSP Conference - $275
Retired Member - $115
District Team Discount (3 or more members from same district) - $275*
*To be given the discount rate and processed, all must be MEMBERS and Full Conference registrations must be received together or at least two full names of others must be provided here:

Note: Member On-Site - $375 / Non-member On-Site - $450 (Postmarked after 10/12/15)

Per Diem Options

Meals in which attendee will participate:

Sunday Banquet***
Sunday Diamond Social
Monday Continental Breakfast
Monday Lunch
Monday An Evening w/Jay Paterno**
Tuesday Breakfast

***Selection for Sunday Banquet (must include meal selection(s)):

Select number of entree(s) desired:

Broiled Filet of Salmon

Parmesan-Crumbed Chicken

Extra Meals (for spouse/guest)

Extra Sunday Banquet*** - $45
Extra Monday Lunch w/Exhibits - $25
Extra Tuesday Buffet Breakfast - $25

I want a copy of Jay Paterno’s book for approx. $20 and will purchase it that evening.

I will be staying at the hotel.
I will not be staying at the hotel.
To make hotel reservations, call: (800) 233-7505 or for online, go to: http://www.thepenn staterhotel.psu.edu/ThePennStaterHotel/conferences-and-events/conferences.cfm.
and use the group code PAEJ15A. Deadline for reservations - 9/16/15 - then subject to availability.

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

Purchase Order #

Purchase Order Date

Total Cost: $0.00

* Verification code

Type characters in Verification Code box.

Username: (PAESSP member number) Password: (Last name, case sensitive, e.g. Smith, Jr.)
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