2017 NYSCATE Annual Conference REGISTRATION FORM

Registration Information First Name _______________________ MI____ Last Name________________________________ Nickname to appear on Badge_________________________________________________________ Twitter User Name _________________________________________________________________ Home Address____________________________________________________________________ City___________________________________________ State____________ Zip______________ Home Phone__________________________Employer____________________________________ Position (Please choose one)

____Classroom Teacher ____Technology Integration ____ Staff Developer ____ Computer Resource Teacher ____Computer Assistant

____Building Administrator ____District Administrator ____Computer Coordinator ____BOCES ____Independent Consultant ____Company Representative

____Director of Technology ____Other:_________________________________________________

Work Address____________________________________________ City _____________________

State_____________ Zip_________ Phone____________________ Fax ______________________ E-mail__________________________________________________ ____I do not wish my e-mail to be shared

Checks and Purchase Orders should be sent to: NYSCATE 8 Airport Park Boulevard Latham, NY 12110

*New to 2017 – 4 full days of conference programming!

Conference Registration (Does not include Pre-Con Workshop sessions) ____Full Conference- 4 Days ($349) ____Single Day- Saturday ($175) ____Single Day- Sunday ($175) ____Single Day- Monday ($175) ____Single Day- Tuesday ($175) ____Presenter Only- Full Conference ($155)

Registration Total: ___________ Hands-On Sessions (Saturday and Sunday, in addition to conference fee)

*please include codes of workshop you are registering for.

______ ______ 8 hours of Pre-conference Workshops ($100) ______ ______ 6 hours of Pre-conference Workshops ($75) ______ ______ 4 hours of Pre-conference Workshops ($65) ______ ______ 2 hours of Pre-conference Workshops ($35)

Hands-On Total: _____________ _______ Maker Faire - Saturday Meals - All Meals are included in conference pricing. Please select the meals you plan on attending:

_____ Saturday Opening Reception ____Sunday Banquet ____Monday Breakfast _____Monday Lunch ____Tuesday Breakfast _____Tuesday Lunch

Dietary Restrictions:__________________________________________

Upgrade to Premium Membership ($50): ________________ Total (Include Hands-On, Conference, Membership) Grand Total: ____________________

Payment Information

Credit Card : Visa MC American Express Discover Check #__________ Purchase Order # ______________ Credit Card #_______________________________________________ Exp. Date_______________________ CVC #: _________________ Name on Credit Card: _______________________________