Summer Institute registration form

Building Foundations for GREAT PUBLIC SCHOOLS

Note: WEA will make room reservations upon receipt of your form. We apologize for any misunderstanding. Room rate is $69 + tax. If you require a single room, you will pay for one/half the room rate. If you double up, WEA pays for the room entirely.
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then in an email to chclark@nea.org paste (ctrl v). An e-mail will be sent showing received.

Map of The Virginian Lodge
750 W Broadway Ave
Jackson WY 83001 800.262.4999 info@virginianlodge.com

June 13-16, 2006...Jackson Virginian Hotel. Form must be received by May 26th. flyer (pdf)

Please provide the following contact information:

Name

Local

Street Address

Address (cont.)

City

Zip/Postal Code

Home Phone

Work Phone

E-mail

I am attending Emerging Leaders, also...yes/no Emerging Leaders registration form please fill out

Choose one of the following options:

Female
Male

Choose one of the following track options:

Impacting Public Policy
Forging Powerful Leaders
Constructing Solid Local Membership

WEA pays 1/2 room cost. Choose one of the following options:

Choose one of the following options:

Would you like a roommate assigned to you? yes/no

Enter your roommate's name in the space provided below.

Name
Local
Street Address
Address (cont.)
City
Zip/Postal Code
Home Phone
Work Phone
E-mail
I am attending Emerging Leaders, also...yes/no	Emerging Leaders registration form please fill out

Summer Institute registration form

Copyright © 2006 Wyoming Education Association. All rights reserved. Revised: 05/09/06

Copyright © 2006 Wyoming Education Association. All rights reserved.
Revised: 05/09/06