NJTESOL/NJBE

2012 SPRING CONFERENCE - May 30 & 31, 2012

Presenter’s Registration Form

Workshops: 8:30-3:30 Wednesday, 8:30-3:30 Thursday

Conference Registration Form

Send one completed form for each person. Splitting a 2-day registration is not permitted.

Name (First)_____________ (Last)_______________________ Phone (H)_____________________

Home Address________________________________________ Phone (W)____________________

City ____________________ State_________ Zip________ County of Residence_________________

E-Mail (please print clearly) _____________________ School District/Affiliation__________________

Registration Process:

1. Mark date of presentation (Wednesday, May 30 and/or Thursday, May 31). There is a $50 registration fee for members and a $85 registration fee for nonmembers for that day. Lunch is a gift of the organization and not included in the registration cost.

2. Presenter registration must be completed March 8, 2012. No refund will be made of this fee. Second day registration will be at the regular price.

3. Each presenter in a group presentation must register separately.

Presenter Registration Due March 8, 2012
Presenter registration	Second Day Registration
c Member Wednesday $50 c Non-Member Wednesday $85 c Member Thursday $50 c Non-Member Thursday $85	c Member Wednesday - $109 c Non-Member Wednesday - $144 c Member Thursday - $109 c NON-Member Thursday - $144
c LCD Payment $25
Poster Session and Graduate Forum Presenter Registration Due March 8, 2012
c Member Wednesday $50 c Non-Member Wednesday $85 c Member Thursday $50 c Non-Member Thursday $85	c Member Wednesday - $109 c Non-Member Wednesday - $144 c Member Thursday - $109 c Non-Member Thursday - $144

*THERE WILL BE NO ON-SITE REGISTRATION*

*No faxed registrations accepted”

Awards Reception May 30 - Wednesday Night 5:30 – 6:30 p.m.

Join your colleagues and NJTESOL/NJBE friends
in a casual get-together after the conference!

Light refreshments will be available.

c I plan on attending reception

c I do not plan on attending reception

Scholarship Fund Donation: c $5 c $10 c $25 c $50 c $100 c Other ____

● Check Method of Payment:

______ Check enclosed (payable to NJTESOL/NJBE, Inc.)

______ Conference Fees _____ Membership Fees (if applicable)† ____ Evening Event

______ Purchase Order (Payable to NJTESOL/NJBE, Inc.)
Registrations forms must be ACCOMPANIED by an actual signed/numbered Purchase Order in order to be processed.
One PO per district is preferred. Please send a list of registrants with the completed forms.

4. Mail to: NJTESOL/NJBE Spring Conference 2012

230 Ashland Ave.
Cherry Hill, NJ 08003

5. Follow Up: Email confirmations will be sent out to all registrants who provide an email address. If your registration is being sent by your school along with a purchase order, please follow up with your school district.

† ONLY for those who wish to join or need to update NJTESOL/NJBE membership and are enclosing membership fees:

c New Membership c $35 One Year

c Renewal c $59 Two Years

Would you like your e-mail address added to the listserv? You will receive e-mail about employment opportunities, workshop and conference announcements, questions about state laws and standards, and more. c Yes c No We sometimes give out member addresses (not e-mail) to our affiliates and other entities for the purpose of informing you of upcoming conferences and workshops of interest. Would you like to have your address provided to others for this purpose? c Yes c No

Please circle ONE or TWO numbers for the Special Interest Group or Groups (SIG) you wish to belong to: 1. Early Childhood (Pre-K – K) 2. Bilingual Elementary Education 3. ESL Elementary Education Grades 1-5 4. ESL Grades 6-8 5. Bilingual Secondary Education 6. ESL Secondary Education 7. Higher Education 8. Teacher Education 9. Special Education 10. Adult Education 11. Parent/Community Action 12. Supervisors First Choice ______ Second Choice _______

See the conference program on our website after February 10, 2012.

For more information: visit - www.njtesol-njbe.org