1. Florida Department of Education and
  1. Florida Association of State and Federal Education Program Administrators
      1. Disney’s Coronado Springs Resort
    1. Please submit this form and fee by October 15, 2004
    2. DO NOT WRITE IN THIS SPACE – FOR STAFF USE ONLY

Florida Department of Education
and

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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: _____________________________________

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