Virginia Technology and Engineering Education Association

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					                                                                                Virginia Technology and
                                                                                 Engineering Education
                                                                                   Registration Form
                                                                                        Annual Summer Conference 2012

                     Virginia Technology and Engineering Education Association Registration Details
                                                  (Print or Type – Please copy form for additional participants)

                         Complete registration forms and submit by June 15, 2012 to receive the early bird discount rate.
School Division:
School E-mail:                                              School Fax Number:
Name of School, Community College, University, or Business:

                                                      Summer Contact Information
Mailing Address:
                                                        (To receive confirmation and further information)
City:                                                                          State:                                      Zip:
Home Phone:                                          Fax:                                               E-mail:

                                     CONFERENCE HIGHTLIGHTS
    Pre-Conference Functions (Graduate Course, In-depth Professional Development Workshops, Industry
     Certification Training)
    Specialized middle and high school workshops on topics ranging for Design and Problem Solving,
     Differentiated Instruction, Workplace Readiness Skills, Industry Tours and Technology Resources
(A) Additional awards banquet tickets cost    Summary of Registration Fees                                   Amount    Method of Payment
                                                                                                            Enclosed     Check Amount $
$31.00 per person.                            VTEEA Member Registration
      extra ticket(s) x $31.00 = $            ($200.00 or $220.00 after June 15, 2012)
                                                                                                                          Credit Card:
                                              Non Member Registration                                                                VISA
                                              ($220.00 or $240.00 after June 15, 2012)                                               Master Card
                                                                                                                                 Amount $
(B) Shirt Size ($15.00 per shirt):            Undergraduate/Graduate attendees
                                              Registration ($100.00 or $120.00 after                                   Cardholder’s Name
       Small         Medium                   June 15, 2012)                                                           Credit Card Number
          Large      X-Large                  CTE Administrator One-Day                                                Expiration Date
                                              Registration (Wednesday only $75.00)
          XX-Large                                                                                                     Make one payment (check or credit card) and
                                              Total of A+B                                                             send to:
       Shirts x $15.00 = $                                                                                                 VTEEA
                                              GRAND Total Registration Fees:                                               P.O. Box 354
                                                                                                                           Waynesboro, VA 22980-0261
Total of A and B = $
                                                                                                                       Registration payments must be "postmarked” by
                                              NOTE 1: Fees non-refundable after June 30, 2012
                                                                                                                       June 15th to receive early registration discount.
                                              NOTE 2: Contact the VTEEA Executive/Secretary to verify
                                              your membership status:
                                              NOTE 3: Once this registration form is submitted you will
                                              receive an email with a link to the workshop descriptions and
                                              workshop sign-up procedures.


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