Conference Registration Form

Please print out and complete BOTH  pages.  Mail to LDA-SD PO Box 9760, Rapid City, SD  57709

2nd Annual LDA-SD Conference

Sign up for:

Cost

Price each

$55.00

$_________

Both Days (Students 1/2 price)

$30.00

$_________

Friday Only (Students 1/2 price)

$30.00

$_________

Saturday Only (Students 1/2 price)

EARLY REGISTRATION DEADLINE

SEPTEMBER 15, 1998

$15.00

$_________

Banquet

Method of Payment

Subtotal:

Check

Total:

School Purchase Order

Name:

Address:

City:

State/Prov:

Country:

Zip/Post. code:

Phone:

E-mail:

THE LUNCHEONS ARE INCLUDED AT NO COST FOR CONFERENCE PARTICIPANTS.  THE FRIDAY EVENING BANQUET IS $15.00.  PER PERSON.  PLEASE INDICATE WHICH OF THESE YOU WILL BE ATTENDING.

FRIDAY LUNCHEON
No Charge

SATURDAY LUNCHEON
No Charge

FRIDAY EVENING BANQUET
$15.00 per person

PLEASE CHECK OFF ONE OF THE FOLLOWING

(  )  TEACHER   (   ) COUNSELOR   (   ) PARENT   (   ) STUDENT  (   ) OTHER: ___________________

TEACHERS AND STUDENTS APPLYING FOR CREDIT:
____ Certification Renewal Credit 
____ Bachelor Degree Credit  ____ Masters Degree Credit at BHSU 

PLEASE CONTINUE ON PAGE #2.

NAME:_______________________________________________ 

Please indicate the sessions you would like to attend with a 1st, 2nd, and 3rd choice.  Room seating varies for each session and is limited.  As many people as possible will be accommodated for each session based on pre-registration.

Friday Sessions
October 2, 1998
Morning                                CHOICE                           Morning                       CHOICE
                       1st         2nd      3rd                                   1st       2nd      3rd

9:00-10:00      ____    ____    ____            8:00-9:00      ____    ____    ____
9:00-10:30      ____    ____    ____            9:00-10:00    ____    ____    ____
10:00-11:00    ____    ____    ____            9:00-11:00    ____    ____    ____
11:00-12:30    ____    ____    ____            10:00-11:00  ____    ____    ____
Afternoon                                                                     11:00-12:00  ____    ____    ____
2:00-3:00       ____    ____    ____             Afternoon
3:00-4:00       ____    ____    ____              1:30-3:00     ____    ____    ____
3:30-5:00       ____    ____    ____              3:00-4:00     ____    ____    ____
4:00-5:00       ____    ____    ____              3:00-4:30     ____    ____    ____

     EXAMPLE:  F4   F7   F11    F4= 9:00-10:30 a.m. "Rewiring the System"

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