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Registration Form
Download PDF Registration Here
Name
_________________________________________________________________________
Street
_________________________________________________________________________
City
______________________________________________Zip __________________________
Work
Phone ____________________________Home Phone _____________________________
E-Mail:
________________________________________________________________________
School/District
__________________________________________________________________
Position
_______________________________________________________________________
Select
from the following morning choices (either one full afternoon or two shorter
sessions)
Indicate
your choice for one Full Afternoon Institute (mark 1 for 1st choice, 2
for 2nd choice).
If
you select a full morning institute, do not select a shorter session.
Full Afternoon Institute (1:15
– 3:10 pm)
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_______1
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_______2
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_______3
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OR
Indicate
your two Short Afternoon Sessions (mark 1 for 1st choice, 2 for 2nd
choice for each).
If
you select a shorter session, do not select a full morning institute.
Session I (1:15 – 2:10pm) Session
II (2:15 – 3:10pm)
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_______ A
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AND
_______ D
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_______ B
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_______ E
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_______ C
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_______ F
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_____
Check here if you are a National Certified Counselor and want CEUs.
No
refund will be made if cancellation occurs within two weeks of the conference.
You
may substitute another person in your place. Please notify our office as soon
as possible
of
any substitutions by calling (585) 395-2258. No refunds if you do not attend
the conference.
Cost:
_____$65 Early Bird Registration (Postmarked Before 9 January 2009)
_____$70 Regular Registration (Postmarked After 9 January 2009)
_____$45 for Graduate
Students
_____$30 for Presenters
Make
checks payable to: Western
New York School Counselors Consortium.
Mail
form with payment before January 26, 2009 to:
Yamalis Hernandez
Department of Counselor Education
The College at Brockport
350 New Campus Drive
Brockport, New York 14420
(585) 395-2258
e-mail: edcga@brockport.edu
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