Advanced Workshop Registration

The Advanced Workshop will be held at the Lake Williamson Center in Carlinville on January 20-22, 2012. The $150 fee covers lodging, meals and all materials needed. Fee increases to $175 per delegate for non-IASC members or registering after January 13.

Please verify all information before submitting this registration form. If you need to change this information after submission, you must e-mail Lorie Demry, Workshop Director, at ldemry@clinton.k12.il.us with changes.

For technical assistance, please contact the Communications Consultant by sending an e-mail to awittenauer@illinoisstuco.com.

Basic Information
Name:
Gender:
Address:
City:
Zip Code:
Phone:
Cell:
E-Mail Address:
School Name:
School Address:
School City:
School Zip:
Advisor Name:
Advisor Home/Cell Phone (in case of cancellation):
You must have attended the Summer Workshop or a Fall Workshop. Please indicate which workshop you attended, as well as the date: