Workshop Registration Form
CLOSING THE ACHIEVEMENT GAP FOR STUDENTS WITH DISABILITIES Cost: $325 per person until March 1, 2012; $395 on or after March 2, 2012 (subject to space availability). Purchase orders, credit card authorization forms or checks must be received by March 1, 2012. (TSS Fax: 707-422-6494, TSS Contacts) CANCELLATION POLICY Cancellations received by February 24, 2012 will be subject to a $50 fee. Cancellations received on or after February 25, 2012 and “No Shows” will be subject to the full registration fee. All cancellations must be submitted in writing. All fields are required. Please remember to click on the Submit button after completing your form.
First Name
Last Name
Title/Position
District (Organization)
Address
City
State
Zip Code
Phone Number
Alternate Phone Number
Email Address
Location / Start Date	Hilton, Ontario, CA-Wed, March 7, 2012
Reason for Registering	Professional Development Personal Improvement
Please tell us how you learned about this workshop	Friends/Colleagues Web Site Email/Flyer Employer
Please indicate your Payment Method	Prepayment (Check/Warrant/Credit Card) If paying by credit card, click here to access the Authorization Form. District Purchase Order [Enter P.O.# below]
	The payment or PO should be received at TSS office by Thursday, March 1, 2012.
Comments
Cancellation Policy Acceptance	I understand and accept the cancellation policy.