Registration

Name of School District/Institution*

Name of Superintendent or Authorized Representative*

School District/Institution’s Mailing Address*

School District/Institution’s
Telephone Number* Include area code, e.g. 123-456-7890

School District/Institution’s
Fax Number*

Name of Contact Person for Team*

Position of Contact Person*

Contact Person’s Telephone Number* Include area code, e.g. 123-456-7890

Contact Person’s Email Address*

Confirm Email Address*

Total Number on Team*

Names of Team Members (separate with commas)*

Description of Proposed Task

Identify Special Needs of Team Members and/or preference or need
for facilitator expertise

Please select an option for your week with us.* All options include daily breakfast and lunch in addition to a banquet dinner on the Thursday evening of the conference.

Team Resident 5-Night Three person team: $2950, each additional member $690 Includes hotel, double occupancy for 5 nights

Team Resident 4-Night Three person team: $2800, each additional member $650 Includes hotel, double occupancy for 4 nights

Team Commuter Three person team: $2400, each additional member $575

or:

Individual Resident 5-Night: $866 Includes hotel, double occupancy for 5 nights

Individual Resident 4-Night: $833 Includes hotel, double occupancy for 4 nights

Individual Commuter: $750

Please choose one of the following:*

YES, Please CoSer our team through Jefferson-Lewis BOCES (NYS BOCES Affiliates Only)

NO, CoSer is not needed or does not apply