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Attendee Registration 10/13/16, 10(01 AM

GaETC 2016 REGISTRATION FORM


November 2 - 4
Georgia International Convention Center, Atlanta

Confirmation/receipt will be sent by email.


Name Badge will be mailed approximately 10 days prior to the conference to the Home Address entered below.
Questions? Email gaetcreg@mcraemeetings.com or call 866-554-2382

PERSONAL INFORMATION REGISTRATION OPTIONS


Title: STEAM Director Please select a conference registration type or code:

First Name: EDDIE Full Conference Registration $200.00


Wednesday Only Registration $160.00
Last Name: NEMEC Thursday Only Registration $160.00
Friday Only Registration $95.00
Suffix: Exhibits Only Registration $55.00

WORK INFORMATION
Please select your approved Group Code:
Job Title: DIRECTOR OF STEM

For office use only:


School/Organization: GAINESVILLE CITY SCHOOLS

Complimentary Registration type:


Work Addr1: 508 OAK ST Choose an Option

For Others select Reg type above and check box:


Work Addr2:

Work City: GAINESVILLE Pre-Conference Workshops - Tuesday, Nov. 1


Hands-on workshops are an additional fee of $70 each with a
Conference Registration. To register for a Workshop only without a
Work State: GA conference registration, please contact Registration Management.

Note: Hands-on workshops are NOT included with a Prepaid Code.


Work Zip: 30501

Number of Workshops (1 or 2) $70.00


Please enter the name of your school district or N/A.
Tuesday 9:00am-12:00pm Workshop choice
School District: GAINESVILLE CITY Choose an Option

Tuesday 1:00pm-4:00pm Workshop choice


CONTACT INFORMATION
Choose an Option

Email: eddie.nemec@gcssk12.net
PAYMENT INFORMATION
Day Phone: 678.520.9649

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Attendee Registration 10/13/16, 10(01 AM

Cell*: Cancellation Policy: All cancellations and requests for refunds must be
made in writing and received by October 7, 2016. No refund requests will
be honored after this date. Requests may be emailed to
Home Addr1: gaetcreg@mcraemeetings.com or mailed to the address below. All
508 OAK ST
cancellations will be subject to an administrative fee of $25.

Home City: GAINESVILLE I have read and understand the cancellation/refund


policy.
Home State: GA

Home Zip: 30501


PAYMENT OPTIONS
Twitter name: CREDIT CARD - (Visa/MC/Amex) Select credit card and submit your
registration. You will be taken to a page to enter your credit card
*For onsite emergencies and urgent conference messages only. information.

OTHER INFORMATION PURCHASE ORDER - Select this option and include the purchase order
number and billing information in the fields provided. An invoice will be
mailed to the billing organization.
DEMOGRAPHICS (please check one box in each
category) CHECK - Check payments MUST be mailed by Oct. 7 for registration
to be valid! If paying by check please make payable and mail as follows:
Position: GaETC Registration
Instructional Technology Specialist 1401 Maclay Commerce Dr
Tallahassee, FL 32312

PREPAID CODE - Please use this payment option only if you were given
Level: a valid prepaid code by your organization and you selected it above.
This option is NOT for purchase order numbers.
District Level

SELECT PAYMENT TYPE


Sector:
Public Education Calculate Total

NOTE: Check payments MUST be mailed by Oct. 7!


GENERAL INFORMATION

Please check all that apply: Payment Method: Credit Card


It is my FIRST TIME attending GaETC. Purchase Order
I do not want a printed program and will access Check submitted with
conference information electronically. Go Green! form
I want to volunteer as a concurrent session Pre-Paid Group Code
FACILITATOR.
I would like to OPT-OUT of receiving emails or hard
copy mailings from our sponsors or exhibitors. For Purchase Order Please Include:
Billing Org: Gainesville City Schools

GaETC may provide the names, work addresses, and email address of its attendees to a Address:
limited number of sponsors and exhibitors. Their support is vital to the conference and 508 Oak Street
assists in reducing the registration costs. GaETC never releases attendees telephone,
fax number or payment information to any other persons or organizations. If you DO
NOT wish to receive these hard copy mailings, please check the box above.
City/St/Zip: Gainesville GA 30501

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Attendee Registration 10/13/16, 10(01 AM

Do you have any special needs? If so, check below: Authorizing lynn.pugh@gcssk12.net
I require special assistance covered under the Supervisor:
Americans with Disabilities Act. You will be contacted (if necessary)
concerning arrangements.
For Purchase Orders Please Include:
Purchase Order #:
0000

Submit Registration

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