Education Leaders Summer Conference 2017 Registration Form
Education Leaders Summer Conference 2017 Registration Form STEP 1 Name:
Dr.
Mrs.
Ms.
Mr.
(first) (middle) (last)
School/District:
Job Title:
Address: (street) (city) (state) (zip code)
Home Address: (street) (city) (state) (zip code)
Work Phone:
Work Fax:
Email: work email preferred
First Name On Badge: Is this your first year as an administrator?
Does your district pay for you to attend this conference? Yes
No
Yes
No
If yes, what was your start date?
STEP 2 This year IPA is offering a pre-conference administrator academy, just like in previous years, and a new, conference administrator academy track. Combined, the two academies will fulfill administrators’ teacher evaluator retraining requirement. The pre-conference administrator academy will also count for the 2016-2017 school year administrator academy requirement, and is only available to conference attendees. The conference administrator academy track will count for the 2017-2018 school year administrator academy requirement. Space is EXTREMELY limited and attendance will be granted on a first come, first served basis. CONFERENCE OPTIONS
IPA MEMBER UNTIL 5/26
IPA MEMBER AFTER 5/26
NON-MEMBER
Pre-Conference Administrator Academy AA#1779
$149
$149
$149
Full Conference (traditional small group track)
$359
$431
$539
Full Conference (administrator academy AA#1801 track)
$359
$431
$539
Thursday Only (traditional small group track)
$245
$294
$367
Thursday Only (administrator academy AA#1801 track)
$245
$294
$367
Friday Only
$155
$186
$233
1-Year Administrator Membership & Full Conference Registration New Member Renewal
$724
$796
-----
1-Year Aspiring Membership & Full Conference Registration New Member Renewal
$158
$158
-----
Total:
STEP 3 ADDITIONAL FEES FOR GUESTS AND RETIRED IPA MEMBERS ONLY
PRICE
Continental Breakfast & Morning Break (Thurs.)
$35
Lunch & Afternoon Break (Thurs.)
$53
Reception (Thurs.)
$43
Continental Breakfast & Morning Break (Fri.)
$35
Total:
# OF TICKETS
Guest(s) name(s):
STEP 4 You can save in multiple people register from the same district for the full conference package. This is only for IPA members and expires after 5/26. Each person must fill out their own form. List those registering here as a cross reference. • $25 off per registrant of full conference fee for 3 to 4 registrants • $50 off per registrant of full conference fee for 5 or more registrants
STEP 5 Cubs Game: Catch a game at historic Wrigley Field with your Summer Conference colleagues! IPA will provide bus transportation to and from the game at Wrigley Field. Meet in the lobby of the Hilton Hotel at 5:00 p.m. on Wednesday, June 7th. Game starts at 7:05 against the Florida Marlins. Seats are limited! Cost of ticket includes bus transportation. Cubs v Marlin Tickets
$90
STEP 6 Payment Information
Amount
Step 2 Total
$
(Minus discount if applicable)
-$
Step 3 Total
$
Signature
Mastercard
Discover
AmEx
Name on Card: Card Number:
Exp. Date:
Check payable to Illinois Principals Association
Step 5 Total TOTAL DUE
Visa
$
PO#
Date
IEIN #
Return completed form to: Mail: Illinois Principals Association, 2940 Baker Dr. Springfield, IL 62703 Fax: 312-277-6652 Email: [email protected] THE FINE PRINT • Registration Fees are determined by the date registration is RECEIVED at the IPA office. • The official IPA name badge is your admission into educational sessions and meal functions, so be sure to wear it at all times during the conference. • Continuing education taken to maintain and improve professional skills may be tax deductible if paid directly by the participant. Contact your accountant for more information. • All cancellations must be received in writing by the IPA. An individual who is registered for the conference and who is unable to attend may: (1) send another individual in their place; (2) receive a credit in the amount of the conference which will be good for all IPA events and merchandise (all credits for events and merchandise expire each June 30); or (3) receive a refund as follows: cancellation received more than five days prior to the conference will receive a full refund, less a $25 service charge; cancellations received within five business days of the conference will receive a full refund, less a $50 service charge. Individuals who do not cancel their reservation and are not in attendance are responsible for full payment. Contact Pam Burdine with questions: [email protected] or 217-525-1385
Dr.
Mrs.
Ms.
Mr.
(first) (middle) (last)
School/District:
Job Title:
Address: (street) (city) (state) (zip code)
Home Address: (street) (city) (state) (zip code)
Work Phone:
Work Fax:
Email: work email preferred
First Name On Badge: Is this your first year as an administrator?
Does your district pay for you to attend this conference? Yes
No
Yes
No
If yes, what was your start date?
STEP 2 This year IPA is offering a pre-conference administrator academy, just like in previous years, and a new, conference administrator academy track. Combined, the two academies will fulfill administrators’ teacher evaluator retraining requirement. The pre-conference administrator academy will also count for the 2016-2017 school year administrator academy requirement, and is only available to conference attendees. The conference administrator academy track will count for the 2017-2018 school year administrator academy requirement. Space is EXTREMELY limited and attendance will be granted on a first come, first served basis. CONFERENCE OPTIONS
IPA MEMBER UNTIL 5/26
IPA MEMBER AFTER 5/26
NON-MEMBER
Pre-Conference Administrator Academy AA#1779
$149
$149
$149
Full Conference (traditional small group track)
$359
$431
$539
Full Conference (administrator academy AA#1801 track)
$359
$431
$539
Thursday Only (traditional small group track)
$245
$294
$367
Thursday Only (administrator academy AA#1801 track)
$245
$294
$367
Friday Only
$155
$186
$233
1-Year Administrator Membership & Full Conference Registration New Member Renewal
$724
$796
-----
1-Year Aspiring Membership & Full Conference Registration New Member Renewal
$158
$158
-----
Total:
STEP 3 ADDITIONAL FEES FOR GUESTS AND RETIRED IPA MEMBERS ONLY
PRICE
Continental Breakfast & Morning Break (Thurs.)
$35
Lunch & Afternoon Break (Thurs.)
$53
Reception (Thurs.)
$43
Continental Breakfast & Morning Break (Fri.)
$35
Total:
# OF TICKETS
Guest(s) name(s):
STEP 4 You can save in multiple people register from the same district for the full conference package. This is only for IPA members and expires after 5/26. Each person must fill out their own form. List those registering here as a cross reference. • $25 off per registrant of full conference fee for 3 to 4 registrants • $50 off per registrant of full conference fee for 5 or more registrants
STEP 5 Cubs Game: Catch a game at historic Wrigley Field with your Summer Conference colleagues! IPA will provide bus transportation to and from the game at Wrigley Field. Meet in the lobby of the Hilton Hotel at 5:00 p.m. on Wednesday, June 7th. Game starts at 7:05 against the Florida Marlins. Seats are limited! Cost of ticket includes bus transportation. Cubs v Marlin Tickets
$90
STEP 6 Payment Information
Amount
Step 2 Total
$
(Minus discount if applicable)
-$
Step 3 Total
$
Signature
Mastercard
Discover
AmEx
Name on Card: Card Number:
Exp. Date:
Check payable to Illinois Principals Association
Step 5 Total TOTAL DUE
Visa
$
PO#
Date
IEIN #
Return completed form to: Mail: Illinois Principals Association, 2940 Baker Dr. Springfield, IL 62703 Fax: 312-277-6652 Email: [email protected] THE FINE PRINT • Registration Fees are determined by the date registration is RECEIVED at the IPA office. • The official IPA name badge is your admission into educational sessions and meal functions, so be sure to wear it at all times during the conference. • Continuing education taken to maintain and improve professional skills may be tax deductible if paid directly by the participant. Contact your accountant for more information. • All cancellations must be received in writing by the IPA. An individual who is registered for the conference and who is unable to attend may: (1) send another individual in their place; (2) receive a credit in the amount of the conference which will be good for all IPA events and merchandise (all credits for events and merchandise expire each June 30); or (3) receive a refund as follows: cancellation received more than five days prior to the conference will receive a full refund, less a $25 service charge; cancellations received within five business days of the conference will receive a full refund, less a $50 service charge. Individuals who do not cancel their reservation and are not in attendance are responsible for full payment. Contact Pam Burdine with questions: [email protected] or 217-525-1385
