This form should give you a confirmation page as verification that all is well.

 

If the online form isn't working properly or you'd otherwise prefer a paper copy of this form, download one by clicking here, then mail the completed form to:

 

Kansas Association of School Psychologists

P.O. Box 1801

Emporia, KS. 66801

 

 

Or you can Fax c/o Jim Persinger to:

620-341-5801

 

 

 

Kansas Association of School Psychologists

2010 Convention Registration Form

A registration form must be filled out on each individual planning to attend.

>

First Name *

Last Name *

Home Mailing Address

Home Address Line 2
(if needed)

City *

State

Zip *

Telephone

- -

Email *

Employer

Employer Mailing Address

Employer Address Line 2 (if needed)

Employer City

Employer State

Zip

Employer Telephone

- -

Special MTSS team rate! A school psychologist, paying early or late registration, may bring up to 3 non school psychologist members of his/her MTSS team at the reduced rate of $50 per team member for one day and $70 per member for two days. :

I am (or by October 1st 2010 will be) a dues-paying member of KASP:

I am a member of KASP who will be attending both days: Amount Due Early $125.00 : Late $155.00

I am a KASP member who be attending Thursday only: Amount Due Early $97.00 : Late $125.00.
I am a KASP member who be attending Friday only: Amount Due Early $97.00 : Late $125.00.

I am not a member of KASP. I will be attending both days: Amount Due Early $155.00 : Late $185.00

I am not a KASP member. I will be attending Thursday only: Amount Due Early $127.00 : Late $155.00.
I am not a KASP member. I will be attending Friday only: Amount Due Early $127.00 : Late $155.00.
I am a student. (Full time-verified: have an advisor email jpersing@emporia.edu from their official school email): Amount Due Early $45.00 : Late $65.00.

I am not a school psychologist, and am an MTSS team member who be attending Thursday only with the following school psychologist:

Amount Due Early $50.00 : Late $50.00.

I am not a school psychologist, and am an MTSS team member who be attending Friday only with the following school psychologist:

Amount Due Early $50.00 : Late $50.00.

I am not a school psychologist, and am an MTSS team member who be attending both Thursday and Friday with the following school psychologist:

Amount Due Early $70.00 : Late $70.00.

If you have problems with this form, please wait a few minutes and try again. If it works properly, it will give you a confirmation receipt.

 

If still giving you trouble, please inform the webmaster at jpersing@emporia.edu of your troubles so I can fix it.  Then check back in a few days, or just download the traditional paper form available at the link on the left, and mail it in.

Copyright (c) 2008 Kansas Association of School Psychologists. All rights reserved.