2010 Summer Acacemy - July 7 & 8 Online Payment and Registration

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The form below is for those who are paying using a credit card or PayPal account only.

Please fill out the form below and click "Submit", verify information.
Then click on the link to pay with a credit card or PayPal account.

When you see the registration information page, verify the information on the information page.
If you made an error, you can re-enter in the correct information and submit the page again, and we will delete duplicates.

Please note, your registration will not be complete until you click on the link to pay using Paypal or credit card, provide payment information and submit.
Once you see a PayPal receipt, your registration will be complete.

Keep your PayPal receipt for your records.

Online payment must be received by 10:00 PM July 3, 2010

Cap on enrollment - 25 participants for each topic.
Topic may be cancelled due to insufficient enrollment by June 25th
$30 Processing fee for cancellations – No refunds after June 25th, 2010
$10 Fee for changes in payment processing
(Please note, your seat will not be reserved until payment is received.)
*THERE WILL BE NO ON-SITE REGISTRATION*

*Required Information

*First Name:	*Last Name
*Home Address 1:
Address 2:
*City:	* State:                                           NJ AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MO MS MT NC ND NE NH NM NY NV OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY   *Zip Code:
*County of Residence:
Phone (H)	Phone (W)
*E-mail:
School Affiliation/District

Topic Choice:

*Choose the topic or topics for one or both days.  (See the links or the flyer for more information.)
Adolescent Literacy (Wednesday) Students with Limited or Interrupted Education (Thursday) Collaborative Teaching (Wednesday) Early Elementary Literacy (Thursday) Instructional Technology for ELLs  Wednesday Thursday Partnering with Preschool: Recipes for Success Wednesday Thursday Preparing Students for Success in College Courses Wednesday Thursday
NJTESOL/NJBE Member (Membership must be valid thru July 2010 or if you are renewing or joining at this time)		Non-Member (Not a current NJTESOL/NJBE member)
One Day           $95	Both Days $189	One Day $112	Both Days $224

• Follow Up: Email confirmations will be sent out to all registrants who provide an email address.

The following section is ONLY for those who wish to join or need to update
NJTESOL/NJBE membership and are enclosing membership fees:

Membership Type:	New   Renewal	Cost:	$35 One Year $59 Two Years
E-mail list: Would you like your e-mail address added to the e-mail list? You will receive e-mail about employment opportunities, workshop and conference announcements, questions about state laws and standards, and more.   Yes         No Affiliate Mail: 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. Please let us know your preference.   Yes         No		Special Interest Groups (SIGS): Please choose ONE or TWO numbers for the (SIGS) 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
Expiration Date: Your membership expiration date is printed on the mailing label of the VOICES newsletter, which will be sent to you four times each year.

* 3. Name on credit card or Paypal account                                                                                            

Verification Code - Type the letters and numbers exactly as you see them.
   

If you have any questions, you can contact us by sending e-mail to: webmaster@njtesol-njbe.org.