Event Registration Form

Event

 Date Cost
Teaching Institute April 6-8, 2011 $500 ($400 for teams of 3 or more individuals from the same school)

Fee includes registration, institute materials, and continental breakfasts and lunches.
* denotes a required field  
* Name
* Dept/Discipline:
* Institution:
* Work Phone:
  Home Phone:
  Fax:
* E-mail:

For multiple person or group registration, enter a contact
person or group representative in the fields at left and the
remaining names, one name per line, below:
* Select Event:
      Teaching Institute (April 6-8, 2011)
 
* Method of Payment:
     Please bill me. Use the following Purchase Order number:
     A check made payable to "Gaston College RPDC" is being sent to:


Gaston College
Regional Professional Development Center (RPDC)
Attn: Virgil Cox
201 Highway 321
Dallas, NC 28034
     I am registering as a participant from the host school. My registration is being paid by my institution.
 
* Payment Amount:

Form Verification (anti-spambot measure):    Is ice hot or cold? 

Questions/Comments/Reasons for Attending:

Cancellation and Refund Policy

Registrations cancelled more than 7 days in advance of an event will receive a 100% refund.

A 75% refund is given if a cancellation is received within 1 week of the event.

A 50% refund is given if a cancellation is received within 24 hours of the event.

This penalty is charged to offset the expenses to Pacific Crest resulting from the cancellation.