Reading Recovery 2009 Conference Information

Who will be attending?
The name entered here will be used for name tags and other materials.

Participant's Name:

Participant's Position:

Participant's e-mail address:

Is the participant a contracted Reading Recovery Teacher?

Yes

If yes, who is the participant's Teacher Leader?

Participant's School / Building:

Participant's School / Building Address:

City:

State:

Zip Code:

Phone Number:

Fax Number:

Who will be paying?

Individual registration fee is $100 per person (covers lunch and refreshments). $85 per person for districts sending three or more participants
	Total amount due
	Please bill my school/agency/institution
	Purchase Order, the purchase order number is
Send the bill to the attention of:
Contact Person:
Contact Person's e-mail address:
Please provide information below as to what organization is paying the bill.
Billing School/Agency/Institution:
Billing Mailing/Street Address:
Billing City:
Billing State:
Billing Zip Code:

Fees include morning refreshments during registration and a lunch. If the participant needs a vegetarian meal or have other dietary restrictions, please include them here:

Submit and receive verification of registration information

Upon hitting the "Submit" button below your information will be sent to the Jones Institute for Educational Excellence (JIEE) at ESU. If you do not receive verification that your registration information was received by JIEE, please contact Christine Zlab at czlab@emporia.edu or 877-378-5433 or 620-341-5372.

Complete your registration by clicking on the "Submit" button below:

Note: The registration information will not be sent until you click on the "Submit" button.

MAKE CHECKS PAYABLE TO:
JIEE

MAIL CHECK/PURCHASE ORDERS TO:
Jones Institute for Educational Excellence
Box 4036
1200 Commercial St.
Emporia, KS 66801-5087

CONTACT INFORMATION:
Christine Zlab at czlab@emporia.edu or 877-378-5433 or
620-341-5372 with any general questions.

ESU INFORMATION:
To find your way to and around Emporia and the ESU campus, visit www.emporia.edu/esu/esumap/campus.htm.

SEND YOUR REGISTRATION TODAY!
Please complete one registration form for each participant. Thank You!