California Special Populations Logo  

Registration for Conference
    All fields are required

1) Conference Fees

(Please check appropriate boxes)
Fees include lunch on both November 30th and December 1st, breakfast on December 1st and a reception on November 30th (no host bar).
  Check One
To be paid no later than
November 15th		 Pre-Conference
(additional)
Individual Registrant ($200) $200 $25
2 registrants ($150 for second person) $350 $50
3 registrants (3rd person FREE) $350 $50
Speaker (entire conference) $200 $25
Speaker (presentation only) $0 n/a
JSPAC Member (current) $0 $0
# Attending:
Names: 1)
2)
3)
*- Multiple registrations are allowed only for those attending as a team. Over three registrants from the same team need to fill out a separate registration form. Speakers must register separately.
Total Registration: :

Organization and/or person responsible for the registration payment/invoice:
Name :  
Institution/Organization :  
Email :  
Address :  
City :  
State :  
Zip :  
Phone :  

2) Registration Information

Please have ONE designated person complete this form for groups of 2 or 3 from the same team.

Registrant #1

    
First Name :  
Last Name :  
Discipline :

ctrl+click
to select
multiple


Other:

System :

ctrl+click
to select
multiple
Institution/Organization :  
Region :
City :  
State :  
Phone- work :  
Phone- cell :
Email address :  
Gender : Male     Female
Ethnicity :

ctrl+click
to select
multiple
Pre-Conference : Will you be attending the pre-conference?
Yes     No

Please check which preconference workshop you will be attending:
Beyond the Culture of Poverty: Creating Class-Equitable Learning Environments, Paul Gorski
Advocacy and Education - Insuring the Future of Your CTE Program, Jonathon Lightman
Grants, CTE Collaboratives and Other Funding Opportunities, TBD
First Conference : Is this your first JSPAC conference?
Yes     No
Lunch : Check the days you will be having lunch:
Tuesday, November 30th      Wednesday, December 1st
Vegetarian Meal(s) : Yes     No
Special Needs

If Yes, Provide Detail
 : Yes     No
Presenting : Are you a presenter at the conference?
Yes     No
If yes, are you attending the entire conference:
Yes     No
If not attending the entire conference, how long will you be attending?

Registrant #2

    
First Name :  
Last Name :  
Discipline :

ctrl+click
to select
multiple


Other:

System :

ctrl+click
to select
multiple
Institution/Organization :  
Region :
City :  
State :  
Phone- work :  
Phone- cell :
Email address :  
Gender : Male     Female
Ethnicity :

ctrl+click
to select
multiple
Pre-Conference :

Will you be attending the pre-conference?
Yes     No

Please check which preconference workshop you will be attending:
Beyond the Culture of Poverty: Creating Class-Equitable Learning Environments, Paul Gorski
Advocacy and Education - Insuring the Future of Your CTE Program, Jonathon Lightman
Grants, CTE Collaboratives and Other Funding Opportunities, TBD
First Conference : Is this your first JSPAC conference?
Yes     No
Lunch : Check the days you will be having lunch:
Tuesday, November 30th     Wednesday, December 1st
Vegetarian Meal(s) : Yes     No
Special Needs

If Yes, Provide Detail
 : Yes     No
Presenting : Are you a presenter at the conference?
Yes     No
If yes, are you attending the entire conference:
Yes     No
If not attending the entire conference, how long will you be attending?

Registrant #3

    
First Name :  
Last Name :  
Discipline :

ctrl+click
to select
multiple


Other:

System :

ctrl+click
to select
multiple
Institution/Organization :  
Region :
City :  
State :  
Phone- work :  
Phone- cell :
Email address :  
Gender : Male     Female
Ethnicity :

ctrl+click
to select
multiple
Pre-Conference : Will you be attending the pre-conference?
Yes     No

Please check which preconference workshop you will be attending:
Beyond the Culture of Poverty: Creating Class-Equitable Learning Environments, Paul Gorski
Advocacy and Education - Insuring the Future of Your CTE Program, Jonathon Lightman
Grants, CTE Collaboratives and Other Funding Opportunities, TBD
First Conference : Is this your first JSPAC conference?
Yes     No
Lunch : Check the days you will be having lunch:
Tuesday, November 30th     Wednesday, December 1st
Vegetarian Meal(s) : Yes     No
Special Needs

If Yes, Provide Detail
 : Yes     No
Presenting : Are you a presenter at the conference?
Yes     No
If yes, are you attending the entire conference:
Yes     No
If not attending the entire conference, how long will you be attending?

3) Payment Method

Payment must be made no later than November 8, 2010.
Please make checks payable to: GCCCD Auxiliary
*   I understand that I must mail payment postmarked no later than November 8, 2010 to:

GCCCD Auxiliary
Attn: JSPAC Coordinator
8800 Grossmont College Drive
El Cajon, CA 92020

For questions please contact Tammy Montgomery at tammy.montgomery@gcccd.edu
*   Cancellations and Refunds:
I understand that Registration fees will be refunded, less a $25.00 administration fee, if cancellation is received in writing no later than November 8, 2010. After that date, registration fees are non-refundable. All refunds will be processed after the conference. Substitutions are allowed. Send names of substitutes and/or cancellation notice to tammy.montgomery@gcccd.edu.

4) Lodging Information
*  

I understand that each person is responsible for their own lodging arrangements.

    For reservations contact:

Sheraton Grand Hotel
1230 J Street
Sacramento, CA 95814
916-447-1700

Be sure to mention the Special Populations (JSPAC) Conference for a special rate (limited number so make your reservation early and no later than November 15, 2010).

5) TRAVEL SCHOLARSHIP INFORMATION
There are a limited number of travel scholarships available (up to $250 each) based on financial hardship. If you would like to apply please contact Tammy Montgomery at tammy.montgomery@gcccd.edu.

6) Submit
Name of person completing this form :
Email:
A confirmation email will be sent to each registrant.