health science career & technical educators washington ...2014+fall+registration.pdf · health...

Health Science Career & Technical Educators Washington

2014 Fall Health Science Educators Summit Registration

Name (legal name per ID):

Name for name badge:

School / District or Organization

Address: Work Home

City/State/ZIP:

Telephone: Work Home Cellular

Preferred Email: Work Home

All Registration costs include Clock Hours, Lunch, Snacks, & Parking. Non-member & New-Affiliationinclude 2014 HSCTE membership. WA-ACTE membership not included as part of any registration.Please complete the HSCTE Membership Form to allow us to receive additional demographic data

New-Affiliation Registration

For registrants who did not attend one of the following: WA-ACTE Summer Conference, WA HOSA State Leadership Conference, WCTSMA Spring Symposium or Summer Leadership, or SkillsUSA WSLSC

$95.00

Non-Member Registration

For registrants who attended one of the Washington State CSTO student leadership, CSTO educator leadership, or WA-ACTE educator professional development conferences above, but HAVE NOT paid HSCTE dues.

$75.00

2014 HSCTE Member Registration

HSCTE membership paid on or after November 1st, 2013 (Payments received after the above date for events held prior to that date do not apply)

$55.00

Vendor Registration $75.00 Late registration or late changes due to membership grouping received on-site or after Oct 1st + $25.00 Credit / Debit Card Fee (per registrant) + $4.00

One form per registrant please Total

Please sign here to acknowledge understanding that registration and CC fees are non-refundable

Specific Needs: (Please select one) No special requirements Vegetarian Other lunch needs:

Other educational needs:

Payment Options Please complete the section below appropriate to your payment method of choice

All Checks and POs must be payable to HSCTE

Multiple registrations can be submitted with a single PO or check if submitted together

Email for PO invoice or CC/DC receipt:

Purchase Order PO Number:

Check Check Number:

Credit / Debit Card (Transaction via Square-up)

CC/DC Number: Billing Zip Code: Expiration: / CCV / Security Code(3-4 digit code on back):

Registration Options: Please mail payments to the registration mail address below By Mail: Hazen High School Attn: Tom Walker 1101 Hoquiam Ave NE Renton, WA 98059

By E-Mail:

treasurer.hscte@gmail.com

Please direct questions to this email address

HSCTE Use Only: Date Received:

Registration Payment Info Payment Received

Registration Confirmation Invoice (PO Only) Receipt (CC/DC or if requested)

THANK YOU FOR YOUR EFFORTS TO IMPROVE HEALTH SCIENCE EDUCATION IN WASHINGTON!