Please choose one of the following registration options:

Registration

$125

Payment Information

Payment Method: Choose One Visa Master Card Purchase Order Check

(If paying by check please print out registration or download mail in form. Mail to: Florida ASCD, 11225 Kapok Grand Circle, Madeira Beach, FL 33708)

CREDIT CARD INFORMATION

Name on Account:

Credit Card Account Number:

Expiration Date:

I authorize FASCD to charge my credit card for conference registration.

PURCHASE ORDER INFORMATION

Purchase Order Number (if applicable): Please fax or mail a hard copy to Florida ASCD.

Please Note:  All registrations must be accompanied by a check, credit card authorization, or hard copy of purchase order.

Name:

Address:

City, State, & Zip:      

Phone: - -    Extension:

Email:

School/District: