Florida Department of Education
and
Florida Association of State and Federal Education
Program Administrators
Fall 2004 State Conference
Disney’s Coronado Springs Resort
November 7-10, 2004
PRESENTS
CONFERENCE REGISTRATION FORM
Please type or print
Name_________________________________________________________________
Title_______________________ Employer /District / School______________________
Address________________________________________________________________
Telephone
______________________________
E-mail______________________________
Please submit this form and fee by October 15, 2004
Pre Registration:
$175.00
Mail to: Diane Dannemiller, Supervisor
With FASFEPA Membership $200.00
Federal Programs
Hernando County Schools
Late/On Site Registration fee:$225.00
919 N. Broad Street
(After October 15, 2004)
Brooksville, FL 34601-2397
With FASFEPA Membership $250.00
Amount enclosed: ___________
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FAX:
352-797-7139
Call: 352-797-7070 x434
Only checks or money orders made payable to FASFEPA will be accepted. No Purchase Orders please.
Cancellation Policy:
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There will be a $50.00 cancellation fee through October 15, 2004. There will be no refund for
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cancellations after October 15, 2004
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DO NOT WRITE IN THIS SPACE – FOR STAFF USE ONLY
Amount Received: $ _______________________ Check #
_________________________________
Paid By: ____________________________________________________ Participant _____ Other ______
Date Received: ________________________ Received By: _____________________________________
