Conference Registration Form 2009

ASU CHILDHOOD SERVICES 2009 Early Childhood Education Conference Registration form Jonesboro, AR ◊ August 10-12

First name

Summer Mailing Address

City

Organization /Workplace

Work Address

TAPP Registry ID # (or SSN)

State

ZIP

Your Preferred Phone #

□ Check here if you plan to attend the Curriculum Institute

E-mail (Important! Your registration confirmation will be e-mailed to you if possible.) Annual Conference Registration—Monday through Wednesday (Aug. 10-12) 1. Early Bird Registration 2. Regular Registration Fees (Through July 20): Fees (If Postmarked by June 15): Registration Box Lunch Dinner (Mon. only)

□ $99 □ $24 □ $12

Undergraduate Credit (1 hr.)

□ $163 Non-Resident □ $427

Resident

Graduate Credit (1 hr.) Resident

□ $208 □ $530

□ $125 □ $24 □ $12

Registration Box Lunch Dinner (Mon. only)

Undergraduate Credit (1 hr.) Resident Non-Resident Graduate Credit (1 hr.) Resident

□ $163 □ $427 □ $208 □ $530

3. One-Day Registration Only Fees: Monday or Tuesday (circle one)

□ $8

Box Lunch 4. Curriculum Institute Fees:

□$175

Registration (includes lunch all 3 days)

Dinner (Mon. only)

Non-Resident Purchase Orders, Money Orders, and Checks Accepted   —> —> —>   TOTAL Registration fee enclosed  Non-Resident

□ $55

Registration

□$12

 $_________

(payable to ASU Childhood Services)  ************************************************************************************************************************************************************************************************************************************************************************************* 

*Undergraduate or Graduate Credit Options are contingent upon prior ASU or ASU Graduate School Admission.  **Lodging & breakfast will not be available on campus this year. Childhood Services has negotiated a conference rate with these area hotels:    Comfort Suites, 3404 Access Road, 870.336‐2280, $93/night , free continental breakfast, indoor pool, free wi‐fi, all rooms suites     Holiday Inn Express, 2407 Phillips Drive, 870.932.5554, $85/night, free continental breakfast, fitness center, free wi‐fi, business center 

Scholarship Information ASU Childhood Services and DHS Division of Child Care and Early Childhood Education are pleased to announce a limited number of  scholarships for the conference. Employees of licensed and registered child care programs are eligible to apply. The purpose of the  scholarship is to improve the quality of early childhood programs in the state of Arkansas through staff development opportunities.  Scholarships are available for centers and family child care homes.    

If awarded, your scholarship will cover the cost of 3‐day registration only. The scholarship will not cover the cost of meals, lodging,  travel expenses, college credit courses, continuing education units (CEUs), or substitute staff costs.    

Scholarships are available on a first‐come, first‐ served basis,   using the following criteria:   Staff employed for less than a year in a child care  facility   Programs on program improvement plans   New child care facilities   Licensed capacity of program 

Check here if applying for scholarship Number of years your program has been in operation Licensed capacity of program

License #

Your position within program Number of years you have been employed in child care Have you attended this conference before?

Return form to ASU Childhood Services, Attn: ECE Conference  PO Box 808  State University, AR 72467  (No faxed forms accepted) 

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39th Annual Early Chilhdood Education Conference ◊ August 10-12, 2009 ◊ ENGAGE, CHALLENGE, INSPIRE, LEAD ◊ www.asuececonference.blogspot.com

Last name