2017 Iowa Family and Consumer Sciences Educators/Iowa Affiliate AAFCS Conference Registration Form

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Please complete all questions. PRINT a copy for your files before submitting this form.
Send Payment and photocopy of this form to:
Kristie Kuhse, IFCSE Conference Coordinator, 216 Elm Street, Waverly, IA 50677

Refunds: Full refunds made prior to May 20, 2017 in writing to Conference Coordinator minus $30 IFCSE/IACTE Membership PLUS a $25.00 handling fee. After June 1, 2017, no refunds will be issued.

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First Name: *

Last Name: *

School District/Organization *

School/Organization Address: *

School/Organization City *

School/Organization Zip Code: *

Work Phone Number: *

Home Address: *

Home City: *

Home Zip Code: *

AEA: *

Northwest

Prairie Lakes

Heartland

Green Hills

Great Prairie

Grantwood

AEA 267

Keystone

Mississippi Bend

Work/School Email: *

Home/Summer Email: *

Cell phone number:

Would you like reminder text messages? *

Yes

Years as an FCS Professional: *

Just completed first year.

2-5 years experience.

6-10 years experience.

11-20 years of experience.

21-25 years of experience

26-30 years experience.

30 + years of experience

First time attending this conference:

Yes

선택해제

Sunday, June 11 Evening Session (Meal will be served) *

Yes

Maybe

Current professional organization membership: *

IFCSE/IACTE (2017-2018 dues paid with registration)

Iowa Affiliate AAFCS/AAFCS

Member of all of these organizations

Full Conference Registration (Sunday-Tuesday). Membership payment required for IFCSE.

$ 195.00 Full Conference Registration (PRIOR to May 20, 2017)

$30.00 Membership Dues (IFCSE and IACTE $15.00 each) *required

One Day IFCSE Conference Registration:

$75.00 - Sunday plus $30 IFCSE Membership

$110.00 - Monday plus $30 IFCSE Membership

$75.00 - Tuesday plus $30.00 IFCSE Membership

선택해제

Late Registration (after May 20, 2017)

Full Conference Registration- (Sunday-Tuesday) $225.00

One Day - $125.00

Membership - $30

One Day Conference Registration (Iowa AAFCS Members are not required to pay IFCSE dues)

$75.00 Monday Only - includes breakfast and lunch

선택해제

AAFCS Membership Number (AAFCS Members only required to list number)

College Student Registration:

$50.00 - Monday only

$50.00 - Tuesday only

$50.00 - Monday and Tuesday

기타:

선택해제

Do you need an invoice? List the Purchase Order Number from your school.

School Business Manager/Supervisor Email: *

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