School Technology Leadership Registration Form

BBC - School Technology Leadership Registration Form

Thursday, July 9, 2009 1:00 p.m. - 5:00 p.m.

Please provide the following contact information
First Name
Last Name
Home Address
City
State
Zip
Phone
E-mail address

A little about you:
What school are you representing?
Are you an Epic teachers?	Yes No
Are you an alumnus of Ball State University?	Yes No

RSVP/Registration
Please choose two presentations/mini workshops
I would like 2 CRU's for attending	Yes No

To register by phone, call (765) 285-5679. To register by fax, print this form and send to (765) 285-4989.