The Bresnahan-Halstead Center at the University of Northern Colorado and the Colorado Department of Education present

Registration fee for the 2018 Special Education Directors’ Academy is $300. If you prefer, send a $50 deposit with your registration form; the balance of $250 will be due by June 1, 2018. Payment for registration fees is by personal/agency check or credit card. If you choose to pay by credit card, the information will be entered securely. Agency purchase orders are acceptable. Registration includes breakfast and lunch each day of the Academy as well as lodging on July 18 and 19, based upon availability at Lion Square Lodge.* As space is limited (one director or assistant director per administrative unit), you are encouraged to get your application in as soon as possible (registration applications will be accepted on a first come/first served basis). Registering for the Academy is your commitment to attend and participate in all sessions, July 18, 19, and 20.

Name
Mailing Address:
Email Address:
Telephone:
Position/Affiliation and
Administrative Unit
Academy Commemorative
T-shirt Request : / Yes (check one): Small Medium Large X-Large
No

I have attended the Special Education Directors’ Academy in previous years (years attended):

I am a first-year director in Colorado (if checked, your registration fee is waived)

*Registration fee covers lodging in a hotel-style room or in a shared two-bedroom condoat Lion Square Lodge OR reimbursement up to $200/night for your lodging at another venue of your choice (please request reimbursement form). Please indicate your willingness to share lodging with another participant and provide that individual’s name (if known):

I prefer a lodge/hotel style room.

I am willing to share a two-bedroom condo.

I will be sharing with:

I prefer lodging at a venue of my choice and need reimbursement form.

As part of the meals provided to participants, a boxed lunch will be available on Friday. Please indicate your sandwich preference:
Sliced turkey breast with pepper jack cheese Sliced portabella with fresh mozzarella
Please note any food requirements you may have (allergies, vegetarian, etc.):
Payment Information
Payment for registration fees is by personal/agency check or credit card. If you choose to pay by credit card, the information will be entered securely.
Check / Check # / Amount: $
VISA/MC
Please print clearly / Exp. Date: CVC
Amount authorized: $
Name on card:
Signature: ______
Purchase Order From: / Amount: $
Other Payment Source:

Make checks payable to: University of Northern Colorado

Mail completed registration form and registration fee/deposit to:

Bresnahan-Halstead Center

c/o School of Special Education, McKee 29, Campus Box 141

University of Northern Colorado

Greeley, CO 80639

An acknowledgment of your payment will be sent to you. In the event of your cancellation, half of the payment will be returned to you if notification is received two weeks prior to the Academy. Contact Lorae Blum by phone (970) 351-1626 or email if you have questions regarding your registration.