Registration for 2012 IN-NELL Conference

The ABC’s of TPRS

Sat., March 3, 2012

8:00a.m.-3:30p.m.

Eastwood Middle School

4401 E 62nd. St.

Indianapolis, IN 46220

Early Bird Deadline:  Februrary 15, 2012

General Information:

• Cost*:

$50.00 Regular Registration (postmarked by February 15)

$35.00 Student Registration (postmarked by February 15)

$60.00 Late and On-site Regular Registration (Feb. 16-Conference)

$45.00 Late and On-site Student Registration (Feb. 16-Conference)

*Cost includes IN-NELL Membership for one year, continental breakfast, lunch, and conference materials.

• No refunds will be offered.

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Registration Form for March 3, 2012 IN-NELL Conference

The ABC’s of TPRS

(Please print clearly or type)

Name:   ______________________________________________________________________________

Last                                                      First

Home Address:______________________________________________________________________________

Street                                       City                              State                Zip

Phone: _____________________________________________________________________________________                    Home                                       School/Office                             Cell

Email:   _______________________________________________________________________________

School/Institution:_______________________________________________________________________

Work Address:______________________________________________________________________________

Street                           City                                          State                Zip

Position/Title & grades taught______________________________________________________________

* Lunch is included in the registration fees

A box lunch will be provided from Subway.  Lunch will include a 6-inch sub, cookie, and chips.

Beverages will be provided by IN-NELL.

PLEASE CIRCLE ALL CHOICES

Bread:  9-Grain Wheat                  9-Grain Honey Oat                  Italian         Italian Herbs & Cheese

Meat or Vegetarian options: Black Forest Ham

Turkey Breast                  Veggie Delite

Cheese: American         Monterey Cheddar

Toppings: Lettuce                  Tomatoes         Cucumbers         Peppers         Red Onions         Pickles         Olives         Banana Peppers         Jalapeños

Sauces: Mustard                  Honey Mustard                  Sweet Onion

Red Wine Vinegar                  Light Mayo                  Chipotle Southwest         Ranch                           Mayo                                             Oil

Please check one and include payment:

____$50.00 Regular Registration (postmarked by February 15)

____$35.00 Student Registration (postmarked by February 15)

____$60.00 Late and On-site Regular Registration (Feb. 16-Conference)

____$45.00 Late and On-site Student Registration (Feb. 16-Conference)

Mail completed registration form with payment (checks made payable to IN-NELL-NO PURCHASE ORDERS) to:

Frank Regich, IN-NELL Treasurer

7200 N. College Ave.

Indianapolis, IN 46240

Phone: 317-415-8031 E-mail: fregich@parktudor.org

Note: All registrants will receive confirmation and other details

upon receipt of payment for registration.