REGISTRATION FORM
NASP 2016 Summer Conference ● Denver, CO ● July 11–13, 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
PAYMENT INFORMATION – Print or type all information and
return with payment to:
$379
$559
$729
$_____
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 ToT 1
PREPaRE ToT2
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
$_____
EARLY CAREER/
STUD. MEMBER
$219
$359
$479
$_____
NONMEMBER
$439
$619
$789
$_____
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.
FULL RATE
After 5/11/16
$239
$449
$_____
Signature ___________________________________________
SECTION 2: CHOOSE YOUR DAYS – Select your choice of (one) AM/PM workshop per day, Full Day Workshops or PREPaRE ToT 1 and/or 2 workshops. If you
select 1 Day of Conference, the AM/PM workshops must be on the same day.
PREPaRE: If you register for a ToT, you must have completed the corresponding core workshop. If you select ToT2, you must register for Tuesday and Wednesday.
ToT1: I have completed the core PREPaRE 1 Workshop - YES □ NO□
ToT2: I have completed the core PREPaRE 2 workshop - YES □ NO □
Monday, July 11, 2016
AM Sessions:
□ WS01MD
□ WS03MD
□ WS02MD
□ WS04MD
PM Sessions:
□ WS05MD □ WS07MD
□ WS06MD □ WS08MD
Tuesday, July 12, 2016
FULL DAY SESSION: □ FDTD
AM Sessions:
□ WS09TD □ WS11TD □ WS10TD
Wednesday, July 13, 2016
AM Sessions:
□ WS15WD □ WS17WD
□ WS16WD □ WS18WD
PM Sessions:
□ WS12TD □ WS14TD □ WS13TD
PM Sessions:
□ WS19WD □ WS21WD
□ WS20WD □ WS22WD
PREPaRE ToT: □ TOT1TD
PREPaRE ToT 2: □ TOT2TWD
□ TOT2TWD
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.