87th Annual IACTE Conference and Annual Meeting Registration Form
87th Annual IACTE Conference and Annual Meeting Registration Form February 15-17, 2017 ● The President Abraham Lincoln Springfield-a DoubleTree by Hilton Hotel, Springfield, IL Name _____________________________________________________
Name Preferred on Name Badge ________________________________
Title ______________________________________________________
Employer’s Name ___________________________________________
Address ___________________________________________________
City __________________ State _______________ Zip _____________
Phone ____________________________ Fax _____________________
E-Mail ____________________________________________________
Please check one primary affiliate: ❑IAVAT ❑IBEA ❑ICTA ❑IFACSTA ❑IHOA ❑ILAVESNP ❑INRS ❑TEA of IL Please check one or more (if appropriate): ❑First-timer ❑Retired ❑Student ❑IACTE Past-President ❑ _______________________ *In order to receive the Early Bird rate, payment must be received by December 15, 2016.* IACTE 2017 Individual Registration Rates Includes Continental Early Regular Breakfast, Lunch, Bird After: Networking Reception by: Dec. 15 & Awards Dinner on Dec. 15 2/16, Breakfast & Lunch on 2/17 IACTE Professional $200 $225 Members Retired/Student $125 $150 Members Non Member $260 $285 IACTE Conference & OHSA 10 Training Includes all meals By After Dec.15 Dec. 15 Professional Member $225 $250 Retired/Student $150 $175 Members Non Member $285 $310 IACTE Student Registration Includes lunch on By Thursday Dec.15 Student Member with $40 one lunch Non-Student Members $50 with one lunch
Late After Feb. 3
Total
$250
$310 Total After Feb 3 $275 $200 $335 Total After Feb 3 $60
$60
$70
IACTE 2016 Tour Registration Total By Dec. After After 15 Dec. 15 Feb 3 IACTE Members $ 25 $35 $40 Non Members $ 40 $50 $55 Please check one of the following tours and add the fee: Illinois Emergency Management Agency 1:00-4:00 Feb. 16 Memorial Center for Learning and Innovation 2:00-4:00 Feb. 17 IACTE Membership (Attach Form to join or renew) Download form at www.iacte.org Total Amount Due
❑Yes Closing Lunch List Special Dietary Needs: _________________________________________________ Method of Payment: ❑Check ❑Purchase Order Purchase Order # _________ (To take advantage of the Early Bird rate, payment must be received by December 15, 2016.) Friday, Feb. 19
$175
After Dec. 15 $50
You must () Yes for each meal you plan to attend. Meals are included in registration fee. IACTE must pay for the number guaranteed regardless of the number served. Thursday, ❑Yes ❑Yes ❑Yes ❑Yes Feb. 18 Continental Opening Networking Awards Breakfast Lunch Reception Dinner ❑Yes Breakfast
A check or P.O. must accompany registration. Please make all checks payable to the Illinois Association for Career and Technical Education. Return this registration form with your check or P.O. number to: Connie Campbell, 9524 Roanoak Drive, Rockford, IL 61107. Forms can be faxed to Connie Campbell at 815-654-4064 or emailed to Connie at [email protected]. Refund requests must be in writing and will be honored until February 3, 2017. A $50.00 handling fee will be assessed. For questions, please contact Connie Campbell: [email protected], or cell phone #815-978-0839. Conference Hotel Information: ACTE has secured a special conference rate at the President Abraham Lincoln - A Doubletree by Hilton in Springfield, IL for the 2016 $110 for Single/Double, $122 for Triple and $134 for Quad. To book, call 866-788-1860 and use the code ATE. The deadline to book at this rate is January 25, 2017. Professional Development Hours will be available for all sessions. The conference itself will provide an opportunity for eleven Professional Development Hours. The tours will provide an additional two to three Professional Development Hours.
Name Preferred on Name Badge ________________________________
Title ______________________________________________________
Employer’s Name ___________________________________________
Address ___________________________________________________
City __________________ State _______________ Zip _____________
Phone ____________________________ Fax _____________________
E-Mail ____________________________________________________
Please check one primary affiliate: ❑IAVAT ❑IBEA ❑ICTA ❑IFACSTA ❑IHOA ❑ILAVESNP ❑INRS ❑TEA of IL Please check one or more (if appropriate): ❑First-timer ❑Retired ❑Student ❑IACTE Past-President ❑ _______________________ *In order to receive the Early Bird rate, payment must be received by December 15, 2016.* IACTE 2017 Individual Registration Rates Includes Continental Early Regular Breakfast, Lunch, Bird After: Networking Reception by: Dec. 15 & Awards Dinner on Dec. 15 2/16, Breakfast & Lunch on 2/17 IACTE Professional $200 $225 Members Retired/Student $125 $150 Members Non Member $260 $285 IACTE Conference & OHSA 10 Training Includes all meals By After Dec.15 Dec. 15 Professional Member $225 $250 Retired/Student $150 $175 Members Non Member $285 $310 IACTE Student Registration Includes lunch on By Thursday Dec.15 Student Member with $40 one lunch Non-Student Members $50 with one lunch
Late After Feb. 3
Total
$250
$310 Total After Feb 3 $275 $200 $335 Total After Feb 3 $60
$60
$70
IACTE 2016 Tour Registration Total By Dec. After After 15 Dec. 15 Feb 3 IACTE Members $ 25 $35 $40 Non Members $ 40 $50 $55 Please check one of the following tours and add the fee: Illinois Emergency Management Agency 1:00-4:00 Feb. 16 Memorial Center for Learning and Innovation 2:00-4:00 Feb. 17 IACTE Membership (Attach Form to join or renew) Download form at www.iacte.org Total Amount Due
❑Yes Closing Lunch List Special Dietary Needs: _________________________________________________ Method of Payment: ❑Check ❑Purchase Order Purchase Order # _________ (To take advantage of the Early Bird rate, payment must be received by December 15, 2016.) Friday, Feb. 19
$175
After Dec. 15 $50
You must () Yes for each meal you plan to attend. Meals are included in registration fee. IACTE must pay for the number guaranteed regardless of the number served. Thursday, ❑Yes ❑Yes ❑Yes ❑Yes Feb. 18 Continental Opening Networking Awards Breakfast Lunch Reception Dinner ❑Yes Breakfast
A check or P.O. must accompany registration. Please make all checks payable to the Illinois Association for Career and Technical Education. Return this registration form with your check or P.O. number to: Connie Campbell, 9524 Roanoak Drive, Rockford, IL 61107. Forms can be faxed to Connie Campbell at 815-654-4064 or emailed to Connie at [email protected]. Refund requests must be in writing and will be honored until February 3, 2017. A $50.00 handling fee will be assessed. For questions, please contact Connie Campbell: [email protected], or cell phone #815-978-0839. Conference Hotel Information: ACTE has secured a special conference rate at the President Abraham Lincoln - A Doubletree by Hilton in Springfield, IL for the 2016 $110 for Single/Double, $122 for Triple and $134 for Quad. To book, call 866-788-1860 and use the code ATE. The deadline to book at this rate is January 25, 2017. Professional Development Hours will be available for all sessions. The conference itself will provide an opportunity for eleven Professional Development Hours. The tours will provide an additional two to three Professional Development Hours.
