MAKE COPIES AS NEEDED
W
orkshop Registration Form
Workshop Title________________________________________________________ ID# ___________
Date(s) _____________________________________ Fee $___________ (Enclosed _____)
o Request CPDUs
o Request Administrators’ Academy credit
(if applicable)o Request college credit (if applicable) Additional Fee $________ (Collected on first day of workshop)
Name
______________________________________________ _______ Teacher _______ Grade(s)
First Last
SS # ______________________________________________ _______ Administrator
Other
District___________________________________ District # _____________________________________
School___________________________________ School Telephone ______________________________
School Address ___________________________
City/State/Zip ________________________________
Home Address ____________________________ City/State/Zip
________________________________
Home Telephone ____________________________
Email Address ______________________________
o Prefer vegetarian lunch (if available)
CANCELLATIONS / REFUNDS:
If you cannot attend, a cancellation notice should be given to the ROE at least three days before the workshop. Refunds will not be given without a cancellation notice. All workshop monies (if required), including Graduate Credit fees, are due on or before the workshop session. Unless cancellation is received three (3) working days prior to the workshop session, participants are obligated to pay the workshop fee. Make checks payable to Lee/Ogle ROE.
Workshops are generally contingent on minimum enrollments. All fees will be refunded if a workshop is cancelled.
Early registration is encouraged! If you have questions, please call 815/652-2054 x239.
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