Kansas Association of School Psychologists

Kansas Association of School Psychologists

2016 Convention Registration Form

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

Name______

Home Telephone ______Work Telephone ______

Home Address______

Email (very important for conference updates) ______

Employer ______

Employer Phone Number______

*If using a P.O indicate name of business office employee and contact number responsible for processing and payment of P.O______

Amount Due

Early registration – Postmarked before September 16, 2016

_____KASP member $125.00 ______

_____Non-members $195.00 ______

_____One Day Attendance _____Thursday _____Friday $95.00 ______

_____Student (Full time-verified: Have advisor sign your form) $45.00 ______

Advisor signature/University______

Late registration – Postmarked or registering on site after September 16, 2016

_____KASP member $175.00 ______

_____Non-members $225.00 ______

_____One Day Attendance _____Thursday ______Friday $125.00 ______

_____Student (Full time-verified: Have advisor sign your form) $65.00 ______

Advisor signature/University: ______

Refund policy: If you are unable to attend, a full refund will be made if notified by October 3, 2016. There will be no partial refunds as a count to the hotel must be made and KASP will be charge for each person in that count.

On line registration (is preferred) at www.kasp.org
-or-
Send conference registrations to:
Kansas Association of School Psychologists
P.O. Box 1801, Emporia, KS 66801
Registrations may be faxed until September 30 , 2016
c/o Keely Persinger at fax # (620) 341-6290
Questions about registration:
No person will be denied access to or full participation in any KASP 2016 program, event or activity on the basis of sex, race, color, national origin, disability, or age.
Contact Judy Ball, convention chair for assistance or conference information at / Hotel reservations should be made by contacting:
Four Point by Sheraton
530 Richards Drive
Manhattan, Kansas 66502
Reservations: 785-539-5311
Please mention that you are with Kansas Association of School Psychologists when reserving your room. Room rate is $80.00 (single/double) plus taxes; occupancy 6% and sales 8.4%. Tax exempt organizations must provide updated exemption form to hotel prior to taxes being removed. First floor pool-side & first floor King/Business class room are $20.00 more per room. Blocked rooms are available on a first-come-first-served basis. These rooms will be released September 21, 2016 so reserve early. Districts choosing to use a P.O. must contact the hotel to set it up.

KASP is a NASP approved provider of CPDs. NASP Provider #1030