Registration Form � 2012 OST Directors� Retreat

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					             Registration Form – 2012 OST Directors’ Retreat
The 2012 South Dakota Out-of-School Time (OST) Director’s Retreat is aimed at directors, site coordinators
and administrators of before and after-school and/or summer programs, including 21st CCLC programs, serving
children and youth in kindergarten through middle grades. Child care center directors providing programming
for school-age children are also welcome!

         The Retreat will be held April 26-27, 2012 at the K Bar S Lodge in Keystone, SD.
Registration Fee: The registration fee for this year’s retreat is $100.00. The Retreat sessions speak to the
needs of program directors, assistant directors, and site leaders who have management, program planning and/or
training responsibilities. The registration fee includes lunch both days, Thursday evening dinner, breaks, and
miscellaneous costs. Breakfast is included in the lodging fee for those staying at the Lodge. For those not
staying overnight at the Lodge, but wanting to join the group for breakfast, a $21.40 fee for Thursday & Friday
breakfasts must be added to the registration fee.

Lodging Info: Lodging rooms have been blocked at the K Bar S Lodge (605)666-4545; or toll free
1(866)522-7724) for the evenings of April 25th, 26th, and 27th at a special conference rate of $46.50/night (for 1-2
people) plus tax & fees. Please mention you are booking under the “2012 OST Director’s Retreat” room block.
Last day to book rooms at the special rate is March 23rd.

Registration Deadline: Friday, March 23rd
   1. Send a completed registration form for each person attending to Early Childhood Connections,
       along with the $100 registration fee (plus $21.40 fee for non-lodger breakfasts, if requesting.).
   2. A receipt for your payment will be sent to you by email once payment is received.
   3. Make check payable to Early Childhood Connections, and send your registration form and
       payment to:
                                            Early Childhood Connections
                                            Attn: OST Director’s Retreat
                                            2218 Jackson Blvd – Suite 13
                                               Rapid City, SD 57702

             2012 South Dakota Out-of-School Time (OST) Director’s Retreat
Name: _____________________________________ Position: _______________________________

Name of Program: __________________________________________________________________

Program Mailing Address (PO or Street): ______________________________________________

City: ______________________________________________ State: ______ Zip: _______________

Telephone: ________________ Email: __________________________________________________

    I am not staying at the Lodge, but plan to join the group for breakfast each day. Add $21.40 to your registration fee.
    (Participants eating breakfast at the Lodge will be given special name badges for access to breakfast each morning.)

    I am interested in college credit for this training. 1 Undergrad./Grad. credit will be available from Augustana - $50.

    I am interested in Continuing Education Credits (CEUs). 1.5 CEUs will be available for $10.

     Registration Contact: Deb Hilt – Early Childhood Connections - (605)342-6464 or (888)999-7759

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