Physical Education Activity Kaleidoscope
2009 Workshop Registration Form
(Print and mail or FAX))
NAME______________________________EMAIL ADDRESS ___________________
HOME ADDRESS____________________________________________________________
CITY________________________STATE________________ZIP________________
SCHOOL NAME____________________________________________________________________
SCHOOL ADDRESS_________________________________________________________________
CITY________________________STATE________________ZIP________________
HOME PHONE NUMBER________________________SCHOOL PHONE NUMBER_______________________________
SS#/CWU STUDENT ID#____________________________________
(Needed if taking workshop for credit)
T Shirt Size (Circle one)
| S | M | L | XL | XXL |
Write in the amount included in the appropriate column.
| Fee | Total | |
| Pre-Registration (Postmarked by April 17, 2009) includes: Attendance to workshop, handouts, gift & lunch) | $60 | |
| Registration after April 17, 2009 | $70 | |
| Lunch | Included | Included |
| 7 Clock Hours | Please contact
the CWU Office of Continuing Education to register for clock hours or
professional development credit. 1-800-720-4503 or 509-963-1504. Do NOT pay for these items on this registration form! |
|
| 1 Professional Development Credit | ||
| TOTAL | ||
Charge my credit card: MC/VISA#___________________________________________
Expiration Date______________________
Card Holder's Name_____________________________________________________
Signature______________________________Date___________________________
Check #______________________________School PO __(Please Attach)__________
Make checks payable to: Central Washington University.
Fill out and send to:
| PEAK 2009 Dept. HHPN Central Washington University 400 E. University Way Ellensburg, WA 98926-7572 |
For Additional Information, Call: Telephone: 509-963-1051 Fax: 509-963-1848 E-mail: mathiask@cwu.edu |