21st Annual METCO Director's Association Conference
Registration
Registration deadline is November 16, 2005

Prefix		 Mr.         Mrs.         Ms.         Dr.         Prof.

First Name		       Last Name     

Suffix		 Jr.     Sr.    Ph.D.    Other             Title   

School District		      
or Institutional Affiliation

Address 1

Address 2

City		     State        Zip    -  

Home Phone		       Work Phone   

Cell Phone		                     Fax   
                                       Pop-up windows must be enabled to view workshop information

Choose Your Workshops

Workshops will be offered in the morning and repeated in the afternoon unless stated otherwise. You may attend two (2) workshops - one in the morning and one in the afternoon. Please indicate your 1st, 2nd, 3rd, and 4th workshop choices, by number, in order of preference.

If your workshop preferences are not indicated, or if the requested workshops are full, alternate selections will be made for you.

Lunch Preference


I prefer		 Chicken        Vegetable Lasagna
Allergies/Dietary Restrictions No      Yes      Please describe   

Payment Method

Please complete a separate registration form for each attendee. The conference registration fee of one-hundred and fifty dollars ($150.00) is non-refundable, and registration is on a first-come, first-served basis. Your registration cannot be honored until (1) a complete registration form and (2) payment, or an approved purchase order number, are received by the conference registrar.


VENDORS ONLY I require      vendor tables @  $150.00/table

Credit Card		 Visa     Master Card    Discover
Card Number
        Expiration Date      mm/yyyy

or Purchase Order #     

Mail or fax a copy of the signed purchase order to:
MDA Conference Registrar; C/O Newton METCO; Newton Education Center; 100 Walnut Street; Newton, MA 02494
(617) 559-6133 Fax
Your registration is not confirmed until your purchase order has been received.

   I prefer to pay by mail Print this completed registration form and mail, along with payment, to Registrar.
Your registration is not confirmed until your check has been received.
How did you hear about the our Conference?   
Direct Mailing       Radio      Internet      Word of Mouth