Dynamic Landscapes 2010

Registration Form

Take me to ON-line Registration

 

Registration (please print)

Name: _____________________________________

Position: ___________________________________

School/Organization: __________________________

District: ____________________________________

Address: ___________________________________

City, State, Zip: _____________________________

Phone: _____________________________________

Fax: _______________________________________

E-Mail: ____________________________________

 

Cost: (includes morning snack, Keynote session, entrance to all workshops, lunch, closing session, door prizes - If you do not select a lunch choice below you will default to Cafeteria)

 

___ May 13 only - $135.00 up to May 1, 2010 $160.00 after

Lunch selection: ___ Cafeteria ___ Boxed ___ Boxed Vegie

 

___ May 14 only - $135.00 up to May 1, 2010 $160.00 after

Lunch selection: ___ Cafeteria ___ Boxed ___ Boxed Vegie

 

___ May 13 & 14 - $235.00 up to May 1, 2010 $285.00 after

Thurs - Lunch selection: ___ Cafeteria ___ Boxed ___ Boxed Vegie

Friday -Lunch selection: ___ Cafeteria ___ Boxed ___ Boxed Vegie

 

Payment Method:

___Check (Make Payable to VITA-Learn)

___ Purchase Order # _____________ (Please include billing address   information below)

                   ________________________________

                   ________________________________

___ Credit Card Type _______________________

          Name on Card: ________________________

          Card #: ______________________________

          Card Security Code: ____________________

          Expiration Date: ____________________

         

Mail to:

VITA-LEARN

c/o Delaney Meeting & Event Management

One Mill Street # 301, Burlington, VT 05401

 

Cancellations received by May 1st will qualify for a refund less a $25.00 administrative fee.

No refunds will be given for cancellations after May 1st.