Register to Attend NTA Conference

National Tutoring Association

Conference Registration Form

Early Registration Deadline: December 31, 2011
Please Print or Type As You Would Like Information to Read on Your Nametag

Last Name_____________________________________ First Name_______________________________

Institution or Affiliation
_______________________________________________________________________________________

Office Address ___________________________________________________________________________________

City _________________________________________________ State ________________ Zip ____________

Phone __________________________________ FAX ___________________________________

Email (required for registration confirmation) ___________________________________________________________________________________________

Current Position or Title _____________________________________________________________________

Please check if this is your first NTA Conference ? Vegetarian Meals

Special Needs _________________________________________________________________

CONFERENCE FEES (Does Not Include Annual Membership
)FULL CONFERENCE


Registration Fee For Members	$275.00-Early Registration received before Dec 31, 2011 $325.00 - Late Registration

For Non-members	$325.00 - Early Registration received by Dec 31, 2011 $375.00 - Late Registration
For Undergraduate Students For Graduate Students	$185.00 - with proof of status $195.00 - with proof of status
PER DAY FEES
Registration Fee to Attend One Day	$185.00 Which day? _______________________
Undergraduate/Graduate Students*	$155.00 Which day? _______________________
* Full time or part-time graduate students not employed full time by the college or university.
TOTAL BASIC REGISTRATION FEES	$ _________________

ADDITIONAL WORKSHOPS:
Basic Tutor Certification	$145.00		Leadership Strategies		$ 75.00
Intermediate Tutor Certification	$145.00		Learning Preferences		$145.00
Advanced Tutor Certification	$145.00		Understanding SES/NCLB		$ 95.00
Academic Coach Certification	$145.00
TOTAL ADDITIONAL WORKSHOP FEES
			$_________________


TOTAL AV FEES (Presenters Only)			$ _________________
TOTAL CONFERENCE FEES ENCLOSED		$ _________________		NTA's FEIN: 35-2196495

Make Checks Payable to the NTA (FEIN:35-2196495)
Send Completed Form with check or PO to:
Dr. Sandi Ayaz, Executive Director
National Tutoring Association PO Box 6840 Lakeland FL 33807-6840

All Fees Are Due Before the Conference Begins
NTA Accepts VISA, MC, AMEX and DISCOVER via fax 863-937-3390