Registration Form - The Connecticut Association for Adult and Continuing Education (CAACE)

Registration Form

Please register before March 1st

Contact Information:

Program/Agency

First Name *

Last Name *

Address

Apt. #/floor

City

State		Zip

Phone *

Fax

CAACE members please check one:
	2-day registration fee $205 (includes lunch)
	Thursday only $125 (includes lunch)
	Friday only $125 (includes lunch)
	Lunch only Thurs. $30
	Lunch only Fri. $30

Non-members please check one:
	2-day registration fee $260 (includes lunch)
	Thursday Only $149 (includes lunch)
	Friday Only $149 (includes lunch)
	Lunch Only Thurs. $35
	Lunch Only Fri. $35

Special CEU Facilitator Rate (for those working at the Conference tracking CEUs):
	2-day registration fee $100 (includes lunch)
	Thursday Only $60 (includes lunch)
	Friday Only $60 (includes lunch)

Amount:	Check Number:	Purchase Order Number:

Full payment is required for all registrations. No cancellations will be accepted after March 8th. You may send a substitute if a registered person is not able to attend.

Please e-mail or call Ellen Thompson at caace@comcast.net or 203-691-5016 if you have any questions, need a special meal, or wish to request special accommodations.

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