PALMETTO STATE TEACHERS ASSOCIATION

Please print this form and return to

PSTA, 1901 B Gadsden Street, Columbia, SC 29201-2033

Or, fax to 803.376.1960

------------- REGISTRATION DEADLINE March 12, 2009 -----------------

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PSTA ANNUAL CONVENTION REGISTRATION FORM

ATTENDEE INFORMATION

Name: ____________________________________________________________________ Telephone: _______________________

Address: _________________________________________________________________________

City/State/Zip: ______________________________________________________________________

School: ___________________________________________________________________________

Email Address: ______________________________________________________________________

Date Attending: March 14, 2009

Time: 8:30 a.m. - 4:00 p.m.

Location: Lexington Municipal Conference Center, 111 Maiden Lane, Lexington, SC 29072

Directions: From I-20 take exit #58 (Hwy. #1) toward Lexington. At the intersection of Hwy. #1 and South Lake Drive (Hwy. #6), turn left and Maiden Lane will be the first street on the right. The Lexington Municipal Complex will be immediately on your left.

Registration Fee: PSTA Members $40; NonMembers $60;

PSTA student members $15; Student NonMembers $20

Method of Payment (check one): ______ Cash ______ Check ______VISA/MasterCard

VISA/MasterCard __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ exp. date __ __ __ __ last 3 numbers on back of card __ __ __

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