2017 INCITE Registration

First Name *

Last Name *

School you serve *

Male or Female *

Address 1 *

Address 2

City *

State *

Postal Code *

Phone *

Alternate Phone (if applicable)

Email Address *

Conference Rates:

Staff: $410.00

Spouse: $336.00

Meals, Children ages 4-12: $42.00

Meals, Children ages 13+: $84.00

Registration Windows: April 15 and May 15

Options for payment:

1) Pay $100.00 by April 15 and the remainder by May 15.

2) Pay the entire cost by April 15 or by May 15.

3) Pay half by April 15, and the other half by May 15.

After May 15, the cost increases to:

Staff - $460.00

Spouse - $386.00

Please follow the prompts below to complete your registration.

Which payment method are you using? *

Pay $100.00 by April 15

Pay 1/2 by April 15

Pay in full

Pay remaining 1/2 by May 15 (only if April 16 or later)

Are you also registering your spouse? *

Yes

No

Spouse Name *

Are you also reserving meals for your children? *

Yes

No

List your children's names and ages here. *

	Name	Age
1.	Name	Age
2.	Name	Age
3.	Name	Age
4.	Name	Age
5.	Name	Age

Select appropriate boxes for this registration *

Current Total:

$0.00

OTHER amount due

If the above amounts do not correspond to your registration, please fill in amount due here.
EXAMPLE: You paid the $100.00 deposit, and are now submitting the remainder due.