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:
* Job 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, October 20 (All Day) (Lunch included)
Select ONE of the following:

	Rate	Total Payment
NATPL Forum: Leadership Moving Forward	$250	$
Career Pathways Leadership Certification Workshop (Must also register for one Preconference and the Main Conference)	$250	$
College and Career Guidance with	$250	$
Teaching With Meaning: CTE and Academics	$250	$
I will not be attending a workshop.		$

Fees for Preconference, Thursday, October 21 (8:30 a.m. to 11:30 a.m.)
Select ONE of the following:

	Rate	Total Payment
Programs of Study Design Framework	$125	$
Adult Career Pathways - Building Your Capacity	$125	$
Computer Lab - Creating The Perfect Presentation (SOLD OUT)	$125	$
Lean Six Sigma: How Does It Drive Student Learning? (SOLD OUT)	$125	$
I will not be attending a preconference.		$

Fees for General Conference, October 21-23
(See agenda)

	NCPN Member	Nonmember	Total Payment
Preregistration (9/1/10 through 10/4/10)	$500	$540	$
Onsite Registration (after 10/4/10)	$520	$560	$
Spouse (includes receptions and exhibits only)	$60	$60	$
Spouse Name:
If attending the Kuder event on Wednesday, subtract $100	-$100	-$100	-$
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.