REGISTRATION FORM
NASP 2016 Summer Conference ● Bethesda, MD ● July 25–27, 2016
NAME
ADDRESS
CREDENTIALS
CITY
NASP MEMBER #
STATE
JOB TITLE
ZIP CODE
EMPLOYER
E-MAIL
PHONE NUMBER
SECTION 1: REGISTRATION RATES
WORKSHOPS
EARLY RATE
(Through 5/11/16)
1 Day of Conference
2 Days of Conference
3 Days of Conference
TOTAL
MEMBER
$199
$379
$549
$_____
EARLY CAREER/
STUD. MEMBER
$159
$299
$419
$_____
NONMEMBER
$379
$559
$729
$_____
PAYMENT INFORMATION – Print or type all information and
return with payment to:
NASP 2016 Summer Conference
P.O. Box 79469
Baltimore, MD 21279-0469
□ CHECK ENCLOSED - Payment by check must be received by NASP no
WORKSHOPS
FULL RATE
(After 5/11/16)
1 Day of Conference
2 Days of Conference
3 Days of Conference
TOTAL
PREPaRE/ToT
PREPaRE Workshop 1
PREPaRE workshop 2
PREPaRE ToT 1
PREPaRE ToT 2
TOTAL
later than June 15, 2016 in order to process prior to conference.
MEMBER
$259
$439
$609
$_____
EARLY RATE
Through 5/11/16
$199
$389
$199
$389
$_____
EARLY CAREER/
STUD. MEMBER
$219
$359
$479
$_____
NONMEMBER
$439
$619
$789
$_____
FULL RATE
After 5/11/16
$239
$449
$239
$449
$_____
Make checks payable to:
National Association of School Psychologists (NASP).
□ CREDIT CARD NO. _____________________________________
□ Visa □ MC
Exp. Date______________________
Name on card__________________________________________
REGISTRATION TOTAL: $_____________________
□ I have read, understand, and agree to abide by the cancellation
policies outlined on the NASP website.
Signature ___________________________________________
SECTION 2: CHOOSE YOUR DAYS – Select your choice of (one) AM/PM workshop per day, Full Day Workshops, or PREPaRE core and/or ToT workshops for
both Workshops 1 and/or 2. If you select 1 Day Conference, the AM/PM workshops must be on the same day.
PREPaRE and ToT Workshops: ToT registrants must complete the corresponding core workshop to be eligible. Both ToT and core PREPaRE workshops are available.
ToT1: I have completed the core PREPaRE 1 Workshop - YES □ NO□
ToT2: I have completed the core PREPaRE 2 workshop - YES □ NO □
Monday, July 25, 2016
Tuesday, July 26, 2016
Wednesday, July 27, 2016
Thursday, July 28, 2016
AM Sessions:
□ WS01MB
□ WS03MB
□ WS02MB
□ WS04MB
PM Sessions:
□ WS05MB □ WS07MB
□ WS06MB □ WS08MB
PREPaRE 1: □ PP01MB
FULL DAY SESSION: □ FDTB
AM Sessions:
□ WS09TB □ WS11TB
□ WS10TB
PM Sessions:
□ WS12TB □ WS14TB
□ WS13TB
PREPaRE 2: □ PP02TWB
AM Sessions:
□ WS15WB □ WS17WB
□ WS16WB □ WS18WB
PM Sessions:
□ WS19WB □ WS21WB
□ WS20WB □ WS22WB
PREPaRE 2: □ PP02TWB
PREPaRE ToT 2: □ TOT2TWB
PREPaRE ToT 1: □ TOT1TB
PREPaRE ToT 2: □ TOT2THFB
Friday, July 29, 2016
PREPARE ToT 2: □ TOT2THFB
Changes and Cancellations: Refunds (less a $50 administrative fee) will be granted until June 15, 2016; no refunds will be issued after this date. All cancellations and changes must be
submitted in writing to convention@naspweb.org. Questions? Please contact us at convention@naspweb.org, 866-331-6277, or 301-347-1673 with questions or requests for more
information.