Florida Department of Education • K-12 Education • Bureau of Exceptional Education and Student Services

ADMINISTRATORS’ MANAGEMENT MEETING�

FOR EXCEPTIONAL EDUCATION AND STUDENT SERVICES PERSONNEL

Orlando World Center Marriott • Orlando, Florida • November 3-5, 2004

REGISTRATION/INTENT TO SEEK REIMBURSEMENT FORM

FAX to BEESS/AMM @ 850-245-0953

Prior registrations will be honored (see memo). For new registrations, a separate registration form

must be completed by each participant.

Please print legibly.

No FAX cover sheet is needed.

Name

Title

District/Agency/Institution

Mailing Address

Telephone (work)

FAX

Emergency Contact Number (after work hours)

E-mail Address

AMM REGISTRATION—FOR NEW REGISTRANTS ONLY (SEE MEMO)

YES, I plan to attend AMM

and understand that sessions are scheduled from 8:30 AM, Wednesday, 11/3, through

12:30 PM, Friday, 11/5. If you are attending, check one of the following:

I have reservations at The Orlando World Center Marriott, 8701 World Center Drive, Orlando, Florida

(1-800-564-3181) —OR—

I have other accommodations.

NO, I am unable to attend AMM.

Please send follow-up materials.

AMM INTENT TO SEEK REIMBURSEMENT (FOR ELIGIBLE INDIVIDUALS ONLY)

Note:

It is Washington County’s interpretation of Internal Revenue Service (IRS) rules that, for non-employees, they must require

completion of the W-9 (Request for Taxpayer Identification Number and Certification). This form needs to be completed only

once. Taxes will be withheld after total reimbursements of more than $600.00 have been received in a single year. If you would

prefer that taxes not be withheld, PAEC can reimburse your employer, who will then reimburse you. The forms you fill out at the

meeting will allow you to specify this option. Please contact Frances Rogers, 850-638-6131 or Suncom 769-6131, for additional

information.

I am seeking reimbursement as follows (check one only):

For persons who live more than 50 miles from the meeting site, the cost of per diem expenses at state rates

(meal allowance and hotel).

No transportation costs will be reimbursed.

For persons living fewer than 50 miles from the meeting site, the cost of mileage and meal allowance

at state rates.

Please return by October 14, 2004, to BEESS/AMM, Bureau of Exceptional Education and Student Services,