Families of Shelton School Online Registration Form for the ADDA-SR Workshop


Fill out the information below completely. Then click on the register button and you will be registered for the conference.


Registration information

 

 

                      Last Name:  First Name:  
                 Street Address:
                               City:
                           County: 
                             State:
                        Zip Code:
                      Telephone:
                           E-mail:
      Credentials/Profession:

How did you hear about the workshop?

I would like to become a member. Please include $40 for my membership dues.   Please send my newsletter via e-mail.   

Shelton families $30  or 2 from same family $55

Registration cost for Shelton Families   Price
Individual Registration   $30.00
2 Family members  $55.00
Membership
Renewal 
New Member  
I am already a member but do not need to renew my membership at this time.
  $40.00
Thank you for  all your work.  I would like to make a donation of    

Total Amount

   

Payment Method:


Master Card**

Discover**

Visa **

American Express **

PO #        

**Print Name on Card:  
** Account Number:  
** Billing Address:  
** Expiration Date:  

 

School purchase orders will be accepted.

Please include individual registration forms.

Registration must be received in office by Tuesday, September 16, 2008

Add $5 for Walk-in
Registration.

I need a certificate of attendance.

Form Submission


 

 

 
This page designed by Opal Harris.
Copyright © 1995 [ADDA-SR]. All rights reserved.
Revised: August 17, 2008.