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Complete one form per registrant.  Form may be copied.  Please type or print clearly and keep for your records.  Registration is per person and cannot be shared.

 

                                                                                                                     

First Name                       Last Name                         Middle Initial

 

Current PMSA Membership Number     #                                              

(must be included if you are registering as a member)

 

                                                                                                                     

School Name

 

                                                                                                                     

District Name

 

                                                                                                                     

City                                            State                      Zip/Postal Code

 

                                                                                                                     

Work Phone                                              Fax

 

                                                                                                                     

Home Phone

 

                                                                                                                     

E-mail

 

□ Check here if you have a disability that requires special assistance. é

□ Check here if this is your first PMSA Conference.

REGISTRATION FORM

Includes:  Admission to Monday and Tuesday workshops; AM & PM snack breaks; keynote addresses; vendor exhibits; Sunday Awards Banquet and social; Monday lunch and Monday evening fun night.

Full Conference Registration Fees:

Includes:  Monday workshops; AM & PM snack breaks; Monday lunch and keynote address.

Monday Only Registration Fees:

Mail completed form with full payment to:

(Purchase orders not accepted.)

 

PMSA 2006 Conference Registration

Kathy A. Johnson

90 Werstler Avenue

Gilbertsville, PA  19525

Together Everyone Achieves More (TEAM)  ●  PMSA’s 32nd Annual Conference  ●  March 19-21, 2006  ●  State College, Pennsylvania

For more conference information and regular updates visit PMSA at www.pmsaweb.org