NYS CEC 2003 Convention Registration Form

The Metamorphosis of Special Education

Prevention, Adaptation, and Accommodation

Westchester Marriott Hotel, 670 White Plains Road, Tarrytown, NY 10591

(Hotel Reservations 1-800-882-1042. Please ask for NYS CEC special $99 room rate)

November 20 - 22, 2003

Convention Days: November 21 – 22, 2003

Division Day: November 20, 2003

Name: ______________________________ CEC ID#: ________________

Address: ______________________________ Day Phone: ________________

______________________________ Cell or Evening Phone: ______________

E-mail: ______________________________ ____ check here if presenting

If full time student, School/Advisor’s signature_______________________________________________

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CONVENTION REGISTRATION FOR FRIDAY & SATURDAY, NOVEMBER 21-22, 2003

(Full Convention Fee includes: Friday Luncheon and Reception & Saturday Breakfast)

(Circle) Prior to Oct. 24, 2003 After Oct. 24, 2003 1 Day

CEC Members $145.00 $160.00 $ 100.00

Non-member $165.00 $180.00 $ 120.00

Full Time Students $ 75.00 $ 80.00 $ 50.00

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DIVISION DAY REGISTRATION FOR THURSDAY NOVEMBER 20, 2003

CASE Full Day Workshop (Includes Luncheon) $100.00 _____

Student

Full Day Workshops $50.00 $30.00 _____

(Circle) Morning or Afternoon Sessions Only $30.00 $15.00 _____

Workshops*: AM: _______________________ PM: _________________________

* See Save the Dates for Workshop Listings

J Gourmet Boxed Lunch J $20.00 _____

DIVISION DAY REGISTRATION FEE: _____

CONVENTION REGISTRATION FEE: $________

DIVISION DAY REGISTRATION FEE: Please circle Division Day Session Above $________

____I will add $10.00 to sponsor a student $________

TOTAL AMOUNT DUE: $_______

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Please Check one:

____ Check Payable to NYS CEC (in U.S. dollars; $25.00 fee for returned checks)

____ Credit Card (circle one and complete information below) MasterCard Visa

Credit Card #____________________________________ Expiration Date_________

Signature: _______________________________________

____ Purchase Order: Organization: ________________________ #: ___________________

Mail this complete form with check, credit card information or purchase order to:

Alan M. Shear, 20 Claremont Ave., Rye, NY 10580

Or Fax this form with credit card information: (914) 967-7641

For Additional information visit the NYS CEC Web Site, www.nyscec.org

Or E-Mail Alan Shear at amshear@nyscec.org

* No refunds for cancellation after 10/14/03 * No on-site credit card registration

Revised 7/11/2003 paper