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38th Annual NCPSMA Eastern Convention/Workshop *Regular Member Registration Form
Please Print
Name ___________________________________________ Spouse/Guest name(s) (if registering) _________________ Address __________________________________________ City, State, Zip ____________________________________ Name of School System (LEA) _______________________ Office Phone #______________ Fax #_________________ E-Mail Address___________________________________
I wish to register as follows:
Member ($60) each ______________________
Spouse/Guest ($50) each ______________________ Please include name above
Preregistration deadline is August 15, 2010
Late Registration Fee( After August 15, 2010) There will be no refunds after August 15, 2010)
Member ($70) each _________________________ Spouse ($55) each _________________________ Please make checks payable to NCPSMA and mail to NCPSMA, 630 Adams Ridge Road, State Road, NC 28676 LEA's sending one check for multiple registrations need not fill out individual registration forms. A singe sheet listing the individual names of those they wish to register along with the LEA name, address, phone number, fax number and contact person will be sufficient. * Employed by a NC Public School System. All others must register through Roxie Mack at 336 366 4939 or rrm1@surry.net
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