43rd N rtheast Regional Conference on the Social Studies

							                                                                                                                                     Registration Form

                   43rd N rtheast Regional Conference on the Social Studies
                                                                 April 3rd – 5th, 2012
      Return form and remittance to:                                                                     SPONSORING ORGANIZATIONS:
                                                                                                         CONNECTICUT COUNCIL FOR THE SOCIAL
                                                         FORM AND PAYMENT MUST BE                        STUDIES ● MASSACHUSETTS COUNCIL FOR
                 CCSS/NERC 43                            RECEIVED BY MARCH 15, 2012                      THE SOCIAL STUDIES ● MAINE COUNCIL FOR
                                                                                                         THE SOCIAL STUDIES ● NEW HAMPSHIRE
               LOUISE UCHACZYK                          Make checks out to CCSS/NERC 43                  COUNCIL FOR THE SOCIAL STUDIES ●
                32 WHALLEY AVE                                                                           VERMONT COUNCIL FOR THE SOCIAL STUDIES
                                                                                                         ● RHODE ISLAND SOCIAL STUDIES
               MILFORD, CT 06460                                                                         ASSOCIATION ● NEW JERSEY COUNCIL FOR
                FAX: 860-434-7189                                                                        THE SOCIAL STUDIES ● NEW YORK COUNCIL
                                                                                                         FOR THE SOCIAL STUDIES ● NEW ENGLAND
                                                                                                         HISTORY TEACHERS’ ASSOCIATION ●



Registration                                                                                           Please circle your choices
       Registration for a member of a sponsoring group                                                                                             $100.00
                    (In order to qualify for the member reduced rate, you must be a dues paying member of one of the councils listed
                    listed above. Please circle the name of the organization in the box above)
          Registration for non-member                    except for pre-service teachers/retirees – see below                                      $120.00
          Presenter registration                                                                                                                   $100.00
          All registration after March 15th, 2012                                                                                                  $125.00
          Pre-service Teachers                                                                                                                     $25.00
          Retiree registration                                                                                                                     $25.00
          District Pass □ (check here if you are registering as part of a District Pass group)
Tickets
          N.E.H.T.A. Luncheon                       (Wednesday, 12:15pm)                                                                           $25.00
          *** Please indicate your luncheon choice:                      □ chicken                      □ vegetarian
          CCSS Luncheon                             (Thursday, 12:15pm)                                                                            $25.00
          *** Please indicate your luncheon choice:                      □ chicken                      □ vegetarian
                                                                                                                             Total Enclosed    $
Tuesday Workshops (For planning purposes, please indicate the workshops you will attend)
FULL DAY: Teaching with Primary Sources, the Library of Congress, and the Common Core Standards
            Differentiated Instruction in Social Studies           Online Tools for Your Classroom and Beyond
HALF DAY:From Memory to Action: Connecting the Holocaust to Contemporary Genocides          Connecting Students to Their Past
           Geo-Literacy: Developing Knowledge, Skills, and Insights            Graphic Novels in the Social Studies Classroom
           Engaging Students in Collaborative Inquiry through Blended Online Learning
           Teaching American Elections through Film, Television, Music and Technology
           The Heroic Teacher: Using Comic Books to Illuminate Historical Themes
Contact Information               □This is my first time attending NERC
NAME
ADDRESS
CITY/TOWN                                                                STATE                          ZIP
EMAIL
Badge Information
SCHOOL                                                                   SCHOOL CITY/TOWN
CT residents will receive CEUs if they sign in and out. Members of other councils may request certificates of attendance but will be responsible for
determining reciprocity with their local boards of education.   □CT CEUs □Certificate of Attendance
  Everyone who attends NERC 43 must pay a registration fee, including program committee members, council officers, and presenters. Complete a separate
  registration form for each individual. Onsite registration only after March 15th, 2012. Registration is not refundable after March 15th, 2012.