KASA 2010 Summer Institute Registration

July 21-23, 2010* Galt House Hotel and Suites, Louisville

First 500 to register receive a free copy of the book
Six Pillars of Dynamic Schools.

First Name

Last Name

2009-10 was my first year as a KASA member

School District/Agency

Position for 2010-11

Preferred Billing Address

City

State

Zip Code

Office A/C Phone

Office A/C Fax

Mobile Phone

E-mail

* Required

Note: Your information will not be shared with individuals or organizations at any time and will be used for KASA purposes only. This information also enables us to contact you in the event of an emergency.

		Guests attending with me (list names):

		Notes: Limit 2 family members or companions only. Children under the age of 16 are not required to register. Other school administrators may not register as a guest.

A. Summer Institute Registration (6 hours EILA Credit)

(On-site registration required after Monday, July 5, 2010.)

KASA Member $249 (On-site Registration $299)

Nonmember $449 (On-site Registration $499) includes limited complimentary membership to new members joining KASA for the first time.
Note: Member and non member registration includes all general, early bird, and education sessions, exhibit hall, lunch, refreshment breaks and social activities on Thursday, and celebration brunch on Friday.
Retired/Alumni Member* To qualify you must be an active member retiring at the close of the 2009-10 year or have been a retired member and not actively employed by a school district or education agency during 2009-10.		FREE
Note: Retired/Alumni registration does NOT include meal functions. Please order below.
B. Activities & Meals
Golf Scramble (qty.) 7/21/10 @ $50 ea.
Additional Luncheon Ticket Or Retired Member Luncheon Ticket (qty.) 7/22/10 @ $25 ea.
Additional Celebration Brunch Ticket (qty.) 7/23/10 @ $35 ea.

Total Cost Activities --

C. Pre-Event Workshops -- Wednesday, 7/21/10

1. What is it About Me You Can't Teach? Closing the Achievement Gap (6 hrs EILA credit)

$ 150

2. Building Professional Learning Communities: Focusing on Results Rather than Intentions (3 hrs EILA credit)

$ 75

3. You've Been Appointed Principal: Now What? (6 hrs EILA credit)

$ 150

4. How to Think. What to Say. Get Your Message Across. (3 hrs EILA credit)

$ 75

Total Cost of Pre-Event --

Total Registration Fee --

D. Early Bird Discount

If registering by June 14, 2010 a $50 discount may be applied to the regular $249 (member) or $449 (nonmember) institute registration fee. Discount does not apply to pre-event workshops, golf or other activities.

If Applicable, Deduct $50

E. Miscellaneous

1. Challenged Athletes Foundation

Yes, I want to make a $20 donation to the Challenged Athletes Foundation and have enclosed my personal check or credit card information.

Total Charity --

2. Keynote Speaker Books

I wish to purchase the following Keynote Speaker books:

		Out of Our Minds: Learning to Be Creative by Ken Robinson, Ph.D $23
		The Element: How Finding Your Passion Changes Everything by Ken Robinson, Ph.D $25
		The Global Achievement Gap by Dr. Tony Wagner $19
		Learning By Doing by Rick DuFour $30
		Generations Inc. by Meagan Johnson $15

Please Ship my books ($4 shipping charge per item)

I'll pick up my books at the on-site bookstore July 21 or 22.

Note: Many other book titles and professional resources will be available at the Institute Bookstore, July 21-22.

Total Bookstore --

3. Membership Renewal

I wish to renew my KASA membership. Please calculate based on my 2010-11 salary $ and add to my invoice using the PO # listed.

Total Renewal (.003% of Annual Salary)

4. President's Reception, July 21, 2010

I plan to attend the 5th Annual President's Reception, July 21, following the opening session with Sir Ken Robinson. (Note: While there is no cost, checking this box to indicate your attendance assists KASA in planning the event.)

Total Amount Due( Items A-E) $

PAYMENT OPTIONS

	1. Purchase Order from my School District (an invioce will be mailed to your school district)
	My school district has issued a purchase order for my KASA summer institute registration fee and related activities listed above. Purchase Order # School District
	2. Direct Pay Method
	Organizational or personal check (I've printed my registration form and mailed a copy along with a check for the total amount due to KASA 152 Consumer Lane, Frankfort, KY 40601.)

	Charge my American Express VISA Master Card
	Account No.: CVV Code (3-digit on back of Mastercard/VISA or 4-digit on front of American Express) Exp. Date mm/yyyy Name on Card

*Special Accommodations

	Please indicate if you (or your guest) are in need of special accommodations due to a disability.
	Audio Visual Mobile Special Diet Please contact me for specifics.

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