Registration (please print)
 Name: _____________________________________
Position: ___________________________________
School/Organization: __________________________
District: ____________________________________
Address: ___________________________________
City, State, Zip: ______________________________
Phone: _____________________________________
Fax: _______________________________________
E-Mail: ___________________________________
Registration Fees
Cost: (includes Keynote, continental breakfast, entrance to all conference sessions, and lunch)
Pre-conference
Sessions C & E (circle one) - (6:00- 9:00 PM) $399* _______
Sessions A, B, D, F (circle one) (6:00 - 9:00 PM) $75 _______
Conference
Thursday only $150 or after October 19th $175 _______
Friday only $150 or after October 19th $175 _______
Both Days $250 or After October 19th $300 _______
Total _______
Payment Method:
___ Check (Make Payable to VITA-Learn)
___ Purchase Order # _____________ (Please include billing address information so we can invoice you)
________________________
Mail to: ________________________
VITA-LEARN
c/o Delaney Meeting & Event Management
One Mill Street, Suite 301
Burlington, Vermont 05401
* Price of Sessions C & E pre-conference workshop includes Video iPod
Cancellations received by October 19th will qualify for a refund less a $25.00
administrative fee. No refunds will be given for cancellations after October 19th
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