REGISTRATION FORM “Pre-Registration is required to allend and Space is limited” (Please Prin Cleary) |Name [Phone [Email [District School/Job Site Primary Role 1 Educator Ol Parent C1. Community Member Mail registration formstpayments by 10/23/15 To the Office of Strategic Partnerships, Family & Community Relations, 304 Fourth Street SW, Largo, FL 33770 or emailto: robergem@pcsb org Payment Options: Checks: Make checks payable to Pinellas Ed Foundation/AFE ($86.00) Credit Card: Name on Credit Card Address ciy State Zip Code Credit Card # Expiration Date Back of Card 3 digit code “American Express 4 digit code on Front ‘Atlatrate of $425 will be added to your credit card for processing fees. Please complete a separate registration form for each person attending or attach a list ofall names and email addresses.