The 2010 Jostens Renaissance National Conference by ihm18500


									                                                                                                                                     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: (credit card only)                                                                     (please submit a Breakout Session Presentation Form located at
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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