National Forum Registration Form 2008

REGISTRATION FORM
(General Registration)

THE NATIONAL FORUM ON
EDUCATION POLICY
JUNE 30 - JULY 2, 2008/ AUSTIN,TX
RENAISSANCE AUSTIN HOTEL

Rather Register Offline?

1) Registration Info

Organization*

First Name*

Last Name*

Title*

Address*

City/Town*

State*

Zip Code*

Phone*

Fax

E-mail Address*

* Required information

2)	Additional Information
	Please indicate below your affiliation in your organization:*

Business/Education Partnership

Legislator/Legislative Staff

Consultant

Local School Staff

District Staff

National Organization

Federal Agency

School Board Member

Foundation Official

State Agency

Governor/Gov. Staff

SHEEO/SHEEO Staff

Lab/Center

University/College/Staff

Other (list)

3) Registration Fees

Registration Fees include: 2 Receptions, 2 Buffet Breakfasts, 2 Plated Lunches, and
Education Session Materials.

Registration Description:

On or Before May 23

After May 23

General Public--Full Forum Registration

$650

$750

Single Day Registration - check below

$350

$450

MON

TUES

WED

4) Guest Registration Fee (defined as a member of your immediate family or spouse/partner)

Registration Description:		Registration Fee
	Guest	$150

Name for Guest Badge:

Guests may register to attend the social functions only. Please include payment for your guest when you register.

	Guest First Name
	Guest Last Name

5) Meal Functions

Please check all the meal functions you and your guest will be attending*

YOU:
- Monday, 6/30 - Welcome Reception at Hotel
- Tuesday, 7/1 - Networking Buffet Breakfast
- Tuesday, 7/1 - Conant Award Luncheon
- Tuesday, 7/1 - Off-Site Reception
- Wednesday, 7/2 - Networking Buffet Breakfast
- Wednesday, 7/2 - Plenary Luncheon

YOUR GUEST:
- Monday, 6/30 - Welcome Reception at Hotel
- Tuesday, 7/1 - Networking Buffet Breakfast
- Tuesday, 7/1 - Conant Award Luncheon
- Tuesday, 7/1 - Off-Site Reception
- Wednesday, 7/2 - Networking Buffet Breakfast
- Wednesday, 7/2 - Plenary Luncheon

6) Registration: Pre Forum Functions

On the afternoon of Monday, June 30th, ECS has put together a pre-forum function. Please check mark below if you are interested in attending.

1:00-5:00 Tour of local Austin High School

7) Registration: Concurrent Sessions
To assist us in planning, please indicate your concurrent session preferences by selecting one session per time slot. Indicating your preference will not restrict you from attending or require you to attend any of the sessions.

Tuesday, July 1st - 10:00am - 12:00pm

		(241) Exploring the Benefits and Challenges of Involving Students in Policymaking
		(242) The Postsecondary Challenge: Increasing Student Success, Ensuring Affordability and Maintaining Costs
		(243) Policy Levers You Can Promote on Monday (to reduce the achievement gap)
		(244) Improving the Quality of STEM Instruction in America's High Schools

Tuesday, July 1st - 2:15pm - 4:15pm

		(256) Having the Funding Follow the Student...Can it Work?
		(257) Why Do Some Schools Do Better?: How Do We Bridge the Gap Between Research and Policy for English Language Learners
		(258) You Want Fries with That? Improving High School Graduation Rates in the States
		(259) Developing and Delivering a Statewide Coaching Program for School Leaders

Wednesday, July 2nd - 10:00am - 12:00pm

			(346) No More Parallel Play: Governors' Symposia on Early Learning and the Early Grades
			(347) Preparing and Supporting Teachers for Urban Schools
			(348) Creating the 21st Century Community College: Aligning Policy and Practice to Increase Student Success and Meet Workforce Needs
			(349) Using Growth Models to Measure Student Performance

Wednesday, July 2nd - 2:15pm - 5:30pm

			(370) In It to Win It--High-Leverage (Yet Often Overlooked) Elements of P-20 Reform

8) Liability Waiver and Emergency Contact

Please read and check. I agree and acknowledge that I am participating in ECS events and activities as my own free and intentional act and assume responsibility for my own well-being and that of my guest.

*	Please check box for Signature	Date:
Emergency Contact Name:		Phone:
* Required information

9) If not paying by credit card, please indicate below other payment options:

You will be given an opportunity to pay online (on a secure page) after you submit this form.

		Purchase Order - Please provide P.O.#:
		Check (payable to ECS) - Check/money order payments must be drawn in US dollars

10) Special Needs

Please check all that apply:

Diabetic	Food Allergy
Vegetarian	Other Needs