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									            SHIPPENSBURG UNIVERSITY SCHOOL STUDY COUNCIL
                         REGISTRATION FORM
                  “Current Issues and Challenges for Our Public Schools”

                                           April 3, 2012
                                        9:00 am – 12:30 pm
                                   Tuscarora Room / Reisner Hall

Please email this completed form to bmsmall@ship.edu no later than 3/28/12 *


Member Organization ______________________________________________
Telephone___________________________


    1. Name______________________________                              Lunch     ____ yes or ____no
       Title ______________________________
       Email _____________________________

    2. Name______________________________                              Lunch _____yes or _____no
       Title ______________________________
       Email _____________________________

    3. Name______________________________                              Lunch _____yes or _____no
       Title ______________________________
       Email _____________________________

    4. Name______________________________                              Lunch _____yes or _____no
       Title ______________________________
       Email _____________________________

    5. Name______________________________                              Lunch _____yes or _____no
       Title ______________________________
       Email _____________________________

Please add a page for additional names. The fee for additional persons attending workshops is $20 per person.

*You can also register by faxing form to: 717-477-4012

IF YOU HAVE ANY QUESTIONS, PLEASE CALL Dr. Brian Small @ 717.805.2825

								
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