FLDOE Florida Department of Education FASFEPA Florida Association of

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FLDOE Florida Department of Education FASFEPA Florida Association of Powered By Docstoc
					          FLDOE                                  FASFEPA                                 ECTAC
Florida Department of Education           Florida Association of State and   East Coast Technical Assistance Center
                                             Federal Education Program

                                  The 2009-2010 No Child Left Behind
                                     Technical Assistance Forum
                                          April 28 – 30, 2009
                                     Hilton Daytona Beach Oceanfront Hotel
                                             100 North Atlantic Avenue
                                           Daytona Beach, Florida 32118
                                         (386) 254-8200 or (800) 445-8667

                                                PAYMENT FORM
                                            Please complete all areas



   District / School_____________________________________________________________



   Telephone________________________            E-mail_________________________________

  Registration Cost        $150.00                          Mail to: Diane Dannemiller
  FASFEPA Member or Non-Member Rate                         Supervisor of Federal Programs
                                                            Hernando County Schools
  Registration is inclusive of all three days               919 North Broad Street
  No single day registration fee                            Brooksville, FL 34601-2397

     Amount enclosed: ________________                      Or Fax to: 352-797-7139
                                                            Questions: 352-797-7070 x 434

                 Only checks or money orders made payable to FASFEPA will be accepted.

                            Please submit this form and fee by April 14, 2009
                                          No Refunds after April 21, 2009

                       Questions regarding breakout sessions are to be directed to:
                     Sara Dixon (850) 245-9753 or Felicia Williams-Elliott (850) 245-0093