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Please print this form and mail with payment to: PSTA, 2015 Assembly Street, Columbia, SC 29201 _____________________________________________________________________________________________________________________
ATTENDEE INFORMATION Name: ____________________________________________________________________ Telephone: _______________________ Address:______________________________________ Cell:_________________ Email Address:____________________________ School:____________________ Grade/ subject: ______________District:_________________________ Area of Certification:_______________________________ CIRCLE the session(s) that you want to attend: (ALL WORKSHOPS ARE FROM 10:00 TO 2:00 ON SATURDAY) Location: PSTA's new office: 2015 Assembly Street, Columbia, SC 29201 NBCT Seminar Registration Fee: $25.00 (PSTA Member) $40.00 (Non-Member) (lunch included) Method of Payment (check one): _____ Cash ____ Check ____ VISA/MasterCard __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ exp. date: __ __ -- __ __ last three numbers on back of credit card __ __ __ _____________________________________________________________________________________________________________________ |
----------------- REGISTRATION DEADLINE IS THE WEDNESDAY BEFORE EACH SATURDAY SESSION -----------------