Please be sure to mark the session you wish to attend.
*Registration Due Date: October 13, 2009*
Wednesday, Oct. 21, 2009 Serna Center 5735 47th Ave. Sacramento, CA 95824 Half Day-Choose one:(Repeated Session)
Registration fee includes all materials, and refreshments. Individual Registration Fee for half-day session: How Can Training Participation Be Funded?
Training fees may be supported by Title I, English Learner, Professional Development, Site Discretionary, PTA/PTO, Organizational or private funds.
*Unfortunately we are unable to extend refunds after the due date* Registration
STEP 1: Please type or print clearly and duplicate this form for each registrant
_____________________________________________ Elem. / Middle / HS / Other ____________
Last Name First Name Position Title Circle appropriate grade level
__________________________________(_____)__________________(______)___________________ E-mail (confirmation sent to this e-mail) Telephone Number Fax Number ____________________________________________________________________________________ School District ____________________________________________________________________________________ Name of School/Organization and Address
STEP 2: Choose Method of Payment: (must select one)
CHECKS - Make checks payable to: San Diego State University Research Foundation / CPC CREDIT CARD - Please enter contact person’s information below then contact Melissa Popovich@
619-594-3332 to give credit card information.
_____________________________________________________________(______)____________________________________ Contact Person Phone Number
PURCHASE ORDER - Make payable to: SDSU Research Foundation / CPC
(Either PO # or Contact Persons Information Must Be Entered)
_____________________________________________________________________________________$__________________ Name of School/District/Organization Purchase Order Number Amount P.O. Contact Person ______________________________________________________(______)_________________________ Person Handling PO Title Phone number
STEP 3: Important Now fax a copy of the completed form to 619-287-6756 to reserve your space while your payment is being processed.
(Please call to ensure your fax was received).
STEP 4: Send your completed registration form(s) with check or payment information to:
SDSU Research Foundation/California Parent Center 6505 Alvarado Rd., Suite 208 San Diego, CA 92120
Registration Confirmation will be sent to your email above one week prior to training date.. For more information please contact Melissa Popovich at 619-594-4756, email: firstname.lastname@example.org