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