Submit this form ONLY if you are NOT submitting a proposal.
Please print or type information as you would like it to appear on conference materials.
Contact information must be that of the
individual presenter to insure proper delivery of NAPDS benefits.
PRE-REGISTRATION DEADLINE: MARCH 1, 2012!
If you are registering as a participant (not submitting a proposal) please complete the Participant Registration
Form (below) and mail with payment to: 2012 Professional Development Schools National Conference, USC College
of Education, Wardlaw 252, Columbia, S.C., 29208. Payment may be made by check or credit card only. For
your convenience, you may pay by Discover, VISA, MasterCard or American Express. Credit card registrations can
be completed by fax transmission. Cardholder signature is required on the registration form in order to process the
credit card payment. The conference fax number is (803) 777-4807. Be sure to send a completed registration form
if you register by fax. Our Federal Tax ID number is 57-6001153. Please make checks payable to the University of
South Carolina.
No refunds can be made on paid conference registrations. Please contact the Conference Office at (803) 777-1515 to alert us of substitutions. In the unlikely event that we cancel the conference or a workshop, we will notify
you if we have received your registration in advance. The University of South Carolina is not responsible for any
change/cancellation charges assessed by airlines, travel agents, hotels or other similar vendors. By registering for the
conference, you give permission for your likeness to be used in future promotional materials.
Dr.
Mr.
Ms.
Name _________________________________________________________________
First Name (for name badge) ________________________________________________
My Primary Employer:
___ P-12
___ College/University.
___ Other
Title ____________________________ Dept/District. ____________________________
Credit card registrations may be completed by fax transmission. Please transmit completed registration form with method of payment to (803) 777-3035. Our Federal Tax I.D. number is 57-6001153.
I have read and agree with the cancellation policy stated in this brochure.
I am disabled and may require assistance from conference staff.
Complete registration form and mail to:
2012 PDS National Conference
University of South Carolina • College of Education
Wardlaw 252• Columbia, SC 29208
Phone (803) 777-1515• Fax (803) 777-4807
