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Three ways to register:

1. Fill out the attached information and press submit. A confirmation will be sent to you via email.
2. Print this form, fill it out and FAX to 815-642-8339.
3. Call 314-496-4427

Information as it appears on your Credit Card.

First Name Last Name

Address

City State Zip

Phone Number w area code no spaces

Email

Date(s) Desired, to select both dates hold down CTRL key

Select Date(s)

Amount due $.00 @ $149 per person, both days @ $275 per person

Payment Information Select MasterCard Visa Send Check or Purchase Order

Credit Card Number Expiration Month Expiration Yr

If Purchase Order or School District Check, the number

School Name

School Address

School Zip

Participant Name(s)

1. position Teacher Principal PDC Representative Admininstration_Bldg

2. position Teacher Principal PDC Representative Admininstration_Bldg

3. position Teacher Principal PDC Representative Admininstration_Bldg

Cancellations must be submitted in writing at least 7 days before the event start date and time for a full refund, less a $50 cancellation fee. No refunds will be issued for no-shows. No requests for refunds will be accepted within less than 7 days before the event.

We recommend that you do not purchase non-refundable airline tickets.