Office of Special Programs * WV Department of Education
WV Parent-Educator Resource Center (PERC) Project
Parent – Professional Team Training
October 13-16, 2009 * Charleston Marriott, Charleston, WV
REGISTRATION FORM
(Please photocopy this form for additional participants.)
Name/Title__________________________________________County_____________________
Home Mailing Address: _________________________________________________________
City: __________________________________________Zip: ___________________________
Phone: ___________________________E-mail: ______________________________________
OVERNIGHT GUEST RESERVATIONS
____Yes, I live outside a 30 mile radius of
Charleston and I need lodging (and all meals)
for the dates marked:
____ Tuesday , October 13
____ Wednesday, October 14
____ Thursday, October 15
DAY GUEST RESERVATIONS
____I do not need lodging. Please include me
in meal counts for the following dates:
____ Dinner – Tuesday, October 13
____ Lunch – Wednesday, October 14
____ Lunch – Thursday, October 15
____ Dinner – Thursday, October 15
____ Lunch – Friday, October 16
NOTE: Participants are responsible for making their own room reservations by calling
Charleston Marriott at (304) 345-6500 (Rooms are reserved under WVDE/PERC) no later
than Wednesday, September 30, 2009
Estimated mileage (round trip) __________
Estimated tolls (round trip) _____________
Special needs/accommodations? ___________________________________________________
Timely Response Required *** Please return registration form by October 2, 2009
MAIL OR FAX TO:
Betsy Peterson, Office of Special Education Achievement
West Virginia Department of Education
Bldg. 6, Room 304 * 1900 Kanawha Blvd., East * Charleston, WV 25305-0330
Phone: (304) 558-2696 or (800) 642-8541 * FAX: (304) 558-3741