Certified Evaluation Training Registration Form

First Name:

Middle Initial:

Last Name:

Prefix/Title:

Dr. Mr. Ms.

Position:

District:

School:

Address:

City:

Zip Code:

A/C Phone:

Fax Number:

E-mail:

*Required

Please choose a date and location.

August 27-28, 2008 - KEDC, Ashland

September 4-5, 2008 - KY Dam Village, Gilbertsville

September 8-9, 2008 - NKCES, Cold Springs

November 10-11, 2008 - Four Points Sheraton, Lexington

January 15-16, 2009 - Four Points Sheraton, Lexington

CHECK ONE

This is my update training. This is my initial training.

If attending only one day, please specify date:

Payment Options:

Purchase Order # for $200

Check (Note: I've printed this form and mailed it with my check for $200 to 154 Consumer Lane, Frankfort, KY 40601)

All sessions have been approved for 12 hours EILA credit.
Cancellation Policy: Written cancellation will be accepted until 48 hours prior to the date of the session.
KASA reserves the right to cancel any workshop that does not have adequate participation.

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Wayne Young, Executive Director
Rhonda Caldwell, Deputy Director
Clyde Caudill, Legislative Liaison
Shirley LaFavers, Director of Professional Development
Wanda Darland, Communications Specialist

152 Consumer Lane
Frankfort, KY 40601
(800) 928-KASA or
(502) 875-3411

Fax (502) 875-4634