National Forum Registration Form 2009

REGISTRATION FORM
(General Registration)

THE NATIONAL FORUM ON
EDUCATION POLICY
JULY 8 - JULY 10, 2009/ NASHVILLE, TN
SHERATON NASHVILLE DOWNTOWN 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 July 2

After July 2

General Public--Full Forum Registration

$650

$750

Single Day Registration - check below

$350

$450

WED

THURS

FRI

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:
- Wednesday, 7/8 - Welcome Reception at Hotel
- Thursday, 7/9 - Networking Buffet Breakfast
- Thursday, 7/9 - Plenary Luncheon
- Thursday, 7/9 - Off-Site Reception
- Friday, 7/10 - Networking Buffet Breakfast
- Friday, 7/10 - Conant Award Luncheon

YOUR GUEST:
- Wednesday, 7/8 - Welcome Reception at Hotel
- Thursday, 7/9 - Networking Buffet Breakfast
- Thursday, 7/9 - Plenary Luncheon
- Thursday, 7/9 - Off-Site Reception
- Friday, 7/10 - Networking Buffet Breakfast
- Friday, 7/10 - Conant Award Luncheon

6) Registration: Pre Forum Functions

On Wednesday, July 8th ECS has put together a pre-forum function. Please check mark below if you are interested in attending.

Noon-3:00pm Tour of local Nashville 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.

Thursday, July 9th - 11:00am - 12:00pm

		(225) More with Dr. Richard Elmore on Educational and Workforce issues to prepare our Students for Success
		(226) Multi-State Collaboration: Lessons Learned from the New England Compact
		(227) Building Stepping Stones into the Workforce
		(228) P-20 with No Money: Potential for System Alignment in Difficult Economic Times
		(229) How State Universities Can Take the Teacher Preparation Bull by the Horns

Thursday, July 9th - 3:00pm - 4:00pm

		(235) What Does it take for State Policy to Enable Disruptive Innovation?
		(236) 21st Century Skills: Flavor of the Month or Here to Stay?
		(237) Tapping Technology to Maximize Student Achievement
		(238) A New Model to Improve Mathematics Instruction and Student Learning in the Early Years

Friday, July 10th - 10:15am - 12:15pm

			(330) What's Around the Bend for High School Reform
			(331) Using Education to Make the Most of Communities We Call Home: Education, the Economy and Workforce Development
			(332) Getting Past Go: Developmental Education as a Critical State Strategy to Increase College Success
			(333) Assessing 21st Century Skills
			(334) Teaching Quality & Leadership
			(335) It's Easier (and less costly) Than You Think: Creating a Policy Agenda for Linking Early Learning and the Early Grades

Friday, July 10th - 2:30pm - 4:30pm

			(360) Policy Workshop on the American Reinvestment and Recovery Act's Impact on State Education Policy

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