Retention 101 Retreat, September 30 - October 2, 2007

Sponsored by the Educational Policy Institute

Please use this form to register for EPI's Retention 101 Retreat in Virginia Beach, VA. All registrations made after August 31, 2007 must be paid by credit card.

Mr.

Mrs.

Ms.

Dr.

* First Name:

MI:

* Last Name:

Job Title:

Preferred Name for Badge:

Organization:

* Address:

* City:

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Country:

* ZIP/Postal Code:

* Phone:

Fax:

* Email Address:

* Confirmations will be sent by email. If email is returned undeliverable, confirmation will be sent via fax or mail.

How did you find out about the Retention 101?

* Registration Fees:

All registration fees must be paid by credit card after September 15, 2007.

$995 Registration Fee

EPI is now offering private consultations with Dr. Swail and Dr. Diestche at a special rate of $100 an hour for Retention 101 registrants. Groups of four or more from one institution will get 3 hours free. If you are interested in consulting, please select the number of hours you would like below.

* Please inidicate your method of payment. Payment by check will only be accepted on or before September 15, 2007. If you register after that date, payment must be made with a credit card.

Check

Credit Card

Refunds and Cancellations

The cancellation deadline for a full refund is August 31, 2007 (less a $35 administrative fee). All cancellation and refund requests must be received in writing. No refunds will be given after August 31, 2007 for any reason. EPI is not responsible for weather related travel problems, illnesses, or other issues for individual attendees' travel to the conference.

Instructions for Submitting Registration Form

To submit this form to EPI, please click on the "Continue" button below and verify your contact information. Click "Continue to PayPal" to submit the form. If you are paying by check, close the window. You DO NOT need to fill anything out for PayPal if you are paying by check, but you DO need to click the "Continue to PayPal" button to be registered by the system. You will receive a confirmation email within ten minutes of submitting your form. The confirmation email will be from "Formsite" and look like the registration form you just filled out. If you do not receive a confirmation email, or if you have any questions, please contact EPI at info@educationalpolicy.org or 757-430-2200.

To pay by credit card: Once you have clicked on the "Continue" button and verified your contact information, please click on "Continue to Paypal" at the bottom of the form. Fill out the PayPal form that pops up and follow the instructions to complete your payment. You will receive a confirmation email from PayPal once your payment has been processed.

To pay by check: Once you have received your confirmation email from Formsite, your name and information have been stored in the EPI database, however, your registration is not considered complete until EPI has received a check for your registration fee. If you are paying by check, the payment must be received by August 31, 2007. All payments may be made out to the Educational Policy Institute and sent to:

Educational Policy Institute
Retention 101 Conference: VA Beach
2401 Seaboard Rd., Suite 104
Virginia Beach, VA 23456
EIN#: 82-0564426

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