NCPN Registration - National Career Pathways Network

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NCPN ONLINE REGISTRATION FORM

(required fields are marked with an asterisk)

* First Name:
* Last Name:
* First Name for Nametag:
* Title:
* Organization:
* Address:
* City:
* State:
* Zip:
* Phone:
* Fax:
* E-mail:
Membership #:
(To verify membership number, please contact Linda Locke at llocke@cord.org)
Membership Expiration Date:

Select One:

K-12 Educator Postsecondary Educator Employer Other

Educator: Please select one of the following:

Faculty   Counselor   Principal   Superintendent
School Administrator   College Administrator   School Board Member
Local or Regional Career Pathways, Tech Prep, or CTE Director
State Career Pathways, Tech Prep, or CTE Director   Other

Fees for Optional Events, Wednesday, September 30 (All Day) (Lunch included)
Select ONE of the following:

	Rate	Total Payment
NATPL Forum: The Future Is Here... Where Are You?	$250	$
Career Pathways Leadership Certification Workshop (Must also register for one Preconference and the Main Conference)	$250	$
Career Coaching: Connecting Learners to College and Career Pathways	$250	$
Teaching Contextually: Helping Students Experience the Thrill of Learning	$250	$
Technology for Educators 101	$250	$
Hit the Road: Tour the Featherbone Communiversity in Gainesville, Georgia	$250	$
I will not be attending a workshop.		$

Fees for Preconference, Thursday, October 1 (8:30 a.m. to 11:30 a.m.)
Select ONE of the following:

	Rate	Total Payment
Partnering with Business to Address “The Skills Imperative”	$125	$
Funding Sources and Grant Writing	$125	$
Green Pathways 101	$125	$
Technology for Educators 201 (SOLD OUT)	$125	$
NATPL Programs of Study	$125	$
I will not be attending a preconference.		$

Fees for General Conference, October 1-3
(See agenda)

	NCPN Member	Nonmember	Total Payment
Preregistration (8/22/09 through 9/18/09)	$500	$540	$
Spouse (includes receptions and exhibits only)	$60	$60	$
Spouse Name:
Full-time Classroom Teachers Discount - Subtract $50 (does not apply to counselors)	-$50	-$50	-$
NCPN Membership Fee (for new or renewing members)	$75	N/A	$
*Note about NCPN membership renewal:* If membership expires prior to 10/1/09, you must renew membership to receive member discount.
* Total Payment:

Method of Payment (Tax ID# 74-2077794) (W-9 form can be found online at www.ncpn.info <2009 Conference> under <Registration>.

PO #:
Billing Organization:
Billing Address:
City:
State:
Zip:
* Billing Phone:
* Billing Email:
Credit Card:	VISA MasterCard American Express
Name on card:
Card Number:
Exp. Date:
I understand that payment must be included for this registration to be processed and have included payment in the form of a credit card or purchase order to cover my registration. If paying by check, registration must be mailed.