Course Registration Form

//header.a4p Course Registration Form


CharacterPlus Education Conference - Registration Form

Personal Information:

*First Name:		Salutation:
*Last Name:		Nickname: (for nametag)*
*Address:
Address 2:
*City:
*State:	*Country:
*Zip Code:		*Home Phone:
Home Email:		Cell Phone:
* marks required information

School/Company Information:

*School/Company:
*Position/Title:
*Address:
Address 2:
*City:
*State:	*Country:
*District:
*Zip Code:		*Work Phone:
*Work Email:		*Fax:
Website:
* marks required information

Billing Information:

*Bill To:	School/Company Home District
*PO# or Attention To:
	Same as Personal Same as School/Company
*Address:
Address 2:
*City:
*State:	*Country:
*Zip Code:
* marks required information
Prices will be verified by registrar before posting for invoicing. For credit card payments please contact the CSD at 314-872-8282 or via email at info@csd.org. For any CSD Credit, an invoice will need to be sent for signature. See program details for cancellation terms and conditions. Program is subject to change.

Course Information:


Select the title(s) that you would like to attend. For more information, click on each course number.

Title	Course #	Dates	Member Price	Non Member Price
16th Annual Character Education Con…	14074-01	June 23-24, 2010	$341	$424
Circus Flora Fun Night Activity	14074-CF	Wednesday, June 23, 2010	$28	$28
MUNY Opera Fun Night Activity	14074-MO	Wednesday, June 23, 2010	$48	$48

For any program questions, please contact Barbara Levin at 314-692-9721 or via email at blevin@csd.org.

Additional Notes:

In the box below, please enter any special seating, transportation, or dietary needs, as well as any questions you may have about the registration for this event.

(Maximum characters: 250)
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Questions? Please contact the CSD at 314-872-8282 or via email at info@csd.org.

Please submit your registration only once. It may take up to a minute for you to receive your confirmation page.