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Conference Registration Form
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Florida Association of Partners in Education Conference
REV YOUR ENGINES ...
FOR STUDENT ACHIEVEMENT
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April 19-21, 2006
✮
Hilton Daytona Beach Ocean Walk Village
✮
Daytona Beach, Florida
✮
386.254.8200
Questions? Email Registration@MeetingMakersInc.com
Please type or print neatly. Photocopy as needed.
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Register online at www.flpie.net
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Dr.
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Mr.
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Ms.
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Mrs.
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Other ________________
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Name: First __________________________________ Last _______________________________________________________________
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Title____________________________________________________________________________________________________________
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Organization _____________________________________________________________________________________________________
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Mailing Address __________________________________________________________________________________________________
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City______________________________ State______ Zip __________________________________ County______________________
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Telephone _______________________________________ Fax ___________________________________________________________
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E-Mail Address __________________________________________________________________________________________________
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Special Needs: Check here if you require special assistance to participate and attach a written description of your needs. Please
request prior to March 13, 2006. Someone from Meeting Makers will contact you.
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Vegetarian Meals Needed
Registration Fees
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Full Conference Registration
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FAPE Member...............................................................................................$250
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Non-Member .................................................................................................$300
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D
aily Registration
(same for members and non-members)
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Wednesday, April 19.......................................................................................$125
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Thursday, April 20..........................................................................................$110
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Friday, April 21 ..............................................................................................$100
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Special Event
(not included in Full Conference or Daily Registration)
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Commissioner’s Business Recognition Awards
Thursday, April 20 ..................................................#______ x $50 = $______
Additional Guest Tickets
(please indicate # of extra tickets)
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SUNSPRA Medallion Awards Breakfast
Wednesday, April 19 .....................................................#______ x $20 = $______
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Outstanding School Volunteer Awards Luncheon
Friday, April 21 ......................................................#______ x $30 = $______
Membership to FAPE
(pay conference member registration fee)
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One year membership ................................................................................................$25
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Total $_____________
Credit Card Processing Fee
If paying by credit card, please add a 5% processing fee to your total
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Credit Card Fee ........................................................................$_____________
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Grand Total $_____________
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I am a member of FAPE
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First time attendee
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Service Area (check one):
Business Partner
Parent Organization
Community Relations
Principal
District Volunteer Coordinator
School Advisory Council
Education Foundation
School Volunteer
Family Involvement Leader
Title One Staff
Local Community and
Teacher
Government Leader
Other____________________
Mentor
RSVP! Please reserve a ticket for the following events. I will attend.
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(check all that apply)
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(Included in registration fees as a ticketed event.)
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Wednesday: SUNSPRA Breakfast — first 200 registrants
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Wednesday: Opening General Session Lunch
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Friday: Outstanding School Volunteer Awards Luncheon
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Cancellation Policy
Requests for cancellation must be made in
writing. Registration fees will be refunded if request is received by March
17, 2006. After March 17, 200
, registration fees are not refundable and
purchase orders will be invoiced. A $25 processing fee will be deducted
from all refunds.
Substitution Policy
Substitutes are welcome. Please call Meeting
Makers at 850.656.0025 if a substitute will replace the registrant.
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Payment enclosed $_______________ Check #_______________________________
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Credit Card
(check one)
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Amex
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VISA
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MasterCard Amount $__________
Credit Card No.____________________________________________ Exp. Date ___________________
Signature ______________________________________________________________________________
Payment Information
If you wish to pay by check or purchase order, please make it payable to
"FAPE Conference" FEID 59-2141327
Purchase Order $_________________ P.O. #_________________________________
If paying by purchase order, complete a separate registration form for each person on the P.O.
Registration form must be accompanied by a numbered P.O. Requisitions will not be accepted.
Fax accepted only with purchase order or
credit card.
Fax to 850.656.6696
or mail
registration and payment to:
FAPE Conference
c/o Meeting Makers
Inc.
Post Office Box 15106
Tallahassee, FL 32317-5106
Amount Rec’d:$_____________________
Amount Due:$_______________________
Date:________________ By:___________
Do not write in this space. Thank you.