Individual Registration Form The 2010 Jostens Renaissance National Conference 2010 Jostens Renaissance National Conference Please indicate how you will participate in the Orlando, Florida • July 16 –18, 2010 2010 Jostens Renaissance National Conference One form per registrant. Form may be copied. Please type or print clearly. School Display—showcase your Jostens Renaissance Program Two Ways to Register Presenter—lead a breakout session 1. WEB: www.jostens.com/edserv (credit card only) (please submit a Breakout Session Presentation Form located at www.jostens.com/edserv) 2. MAIL: Jostens Renaissance National Conference 3601 Minnesota Drive, Suite 400 Registration Fees Minneapolis, MN 55435 Please make check payable to Jostens Renaissance. Registration Information *Information will appear on name badge Conference Registration Early-Bird (postmarked by 5/1/10) $300 *First Name Standard (postmarked 5/2/10 – 7/9/10) $325 On-Site (after 7/9/10) $375 *Last Name Guest Registration* Early-Bird (postmarked by 5/1/10) $175 *Name of School Standard (postmarked 5/2/10 – 7/9/10) $200 On-Site (after 7/9/10) $250 * Guest registration rate valid for Friday’s Jostens Renaissance Fun Night Address Home School and Saturday’s Awards Gala only. City State Zip Guest Name for name badge (only if paid registrant) Phone# Home School Cell# Total Registration Fees $ E-mail (Please provide an e-mail address that is accessible to you during and after Jostens Renaissance Recognition Awards the close of your school year.) Jostens Renaissance will recognize individuals for outstanding success Please Complete This Important Information and contributions to education at the 2010 Jostens Renaissance National Conference. Please indicate the appropriate recognition categories that Title School Type apply to you. Superintendent High School Principal Junior High/Middle School Administrator/Teacher/Staff Assistant Principal Elementary First Year Educator School Representative 2 – 10 Years in Education Teacher Urban 11 – 19 Years in Education Student Suburban 20 – 29 Years in Education Other Rural 30 + Years in Education How many years has your school had a Renaissance Program? Video and digital images will be taken throughout this conference. Your attendance at this conference New School 10 – 12 Years grants Jostens the right to use those images for promotional materials unless otherwise stated. 1 – 3 Years 13 – 14 Years 4 – 6 Years 15 – 19 Years 7 – 9 Years 20+ Years Check here if this is your first Jostens Renaissance National Conference Jostens, Inc. reserves the right to accept or reject, in its sole discretion, the registration application of any individual or group. Renaissance® and other Jostens value-added programs, seminars and workshops contain proprietary and/or confidential information intended for use by professional educators. Employees, agents and any person affiliated with a competitor of Jostens (defined as any company which produces, markets or sells products similar to those produced, marketed or sold by Jostens) shall not be permitted to register or attend this event.
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