Microsoft Word - NYSCATE 2015 Annual Conference ... annual confe Web view2017 NYSCATE Annual Conference REGISTRATION FORM. ... Microsoft Word - NYSCATE 2015 Annual Conference

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Microsoft Word - NYSCATE 2015 Annual Conference Registration.docx


Registration Information

First Name _______________________ MI____ Last Name________________________________

Nickname to appear on Badge_________________________________________________________

Twitter User Name _________________________________________________________________

Home Address____________________________________________________________________

City___________________________________________ State____________ Zip______________

Home Phone__________________________Employer____________________________________

Position (Please choose one)

____Classroom Teacher

____Technology Integration

____ Staff Developer

____ Computer Resource Teacher

____Computer Assistant

____Building Administrator

____District Administrator

____Computer Coordinator


____Independent Consultant

____Company Representative

____Director of Technology


Work Address____________________________________________ City _____________________

State_____________ Zip_________ Phone____________________ Fax ______________________


____I do not wish my e-mail to be shared

Checks and Purchase Orders should be sent to:


8 Airport Park Boulevard

Latham, NY 12110

*New to 2017 4 full days of conference programming!

Conference Registration (Does not include Pre-Con Workshop sessions)

____Full Conference- 4 Days ($349)

____Single Day- Saturday ($175)

____Single Day- Sunday ($175)

____Single Day- Monday ($175)

____Single Day- Tuesday ($175)

____Presenter Only- Full Conference ($155)

Registration Total: ___________

Hands-On Sessions (Saturday and Sunday, in addition to conference fee)

*please include codes of workshop you are registering for.

______ ______ 8 hours of Pre-conference Workshops ($100)

______ ______ 6 hours of Pre-conference Workshops ($75)

______ ______ 4 hours of Pre-conference Workshops ($65)

______ ______ 2 hours of Pre-conference Workshops ($35)

Hands-On Total: _____________

_______ Maker Faire - Saturday

Meals - All Meals are included in conference pricing. Please select the meals you plan on attending:

_____ Saturday Opening Reception ____Sunday Banquet

____Monday Breakfast _____Monday Lunch

____Tuesday Breakfast _____Tuesday Lunch

Dietary Restrictions:__________________________________________

Upgrade to Premium Membership ($50): ________________

Total (Include Hands-On, Conference, Membership) Grand Total: ____________________

Payment Information

Credit Card : Visa MC American Express Discover

Check #__________ Purchase Order # ______________

Credit Card #_______________________________________________

Exp. Date_______________________ CVC #: _________________

Name on Credit Card: _______________________________