Dynamic Landscapes 2008
Registration Form
Registration (please print)
Name: _____________________________________
Position: ___________________________________
School/Organization: __________________________
District: ____________________________________
Address: ___________________________________
City, State, Zip: _____________________________
Phone: _____________________________________
Fax: _______________________________________
E-Mail: ____________________________________
Cost: (includes morning snack, Keynote session, entrance to all workshops, lunch, closing session and FREE Web Cam)
$135.00 up to April 30, 2008
$160.00 after April 30, 2008
Payment Method:
___Check (Make Payable to VITA-Learn)
___ Purchase Order # _____________ (Please include billing address information)
________________________________
________________________________
Credit Card Type _______________________
Name on Card: ________________________
Card #: ______________________________
Card Security Code: ____________________
Expiration Date: ____________________
Mail to:
VITA-LEARN
c/o Delaney Meeting & Event Management
One Mill Street # 301, Burlington, VT 05401
Cancellations received by May 2nd will qualify for a refund less a $25.00 administrative fee.
No refunds will be given for cancellations after May 2nd.
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