Registration for the 2010 International Montessori Conference Attendee’s Name (please print):_______________________________________________ School/Organization Name:___________________________________________________ Email address (only method we use to confirm your registration)_______________________________ Mailing address:_____________________________________________________________ __________________________________________________________________________ THIS FOLLOWIING IS MY SCHOOL/HOME (PLEASE CIRCLE ONE) Daytime phone number (just incase): __________________________________________ ❑ I am an IMC member/Membership #_______________ ❑ I’m not a member, please make me an ind member & add $45 to my registration fee renew my individual membership if necessary ❑ Please add $250 for IMC School membership to the fee and give us the discount for the group. Each IMC member pays the discounted price for registration: ❑ Full conference $375 ❑ 2-day $275 ❑ 1 day $175 ❑ I do not wish to become a member and agree to pay ❑ Full conference $475 ❑ 2-day $375 ❑ 1 day $275 Groups of 6 or more from an IMC school pay $350 per person. Should your IMC membership not be current we will automatically charge the appropriate level of membership to your registration. Days of attendance (please mark which one applies): ❑ Full conference ❑ Fri./Sat. ❑ Sat/Sun ❑ Fri. ❑ Sat. ❑ Sun. IMPORTANT: PLEASE TELL US ❑ I will attend the dinner on Thurs evening ❑ I will not be attending dinner on Thurs ❑ I am staying for the plated lunch on Sun ❑ I am not staying for lunch on Sun Please specify if you have any severe food allergies that we need to know about_____________________ EMAIL (we only confirm via email and most of our news comes out in email. We cannot email to info@email addresses): Credit Card information. A receipt is generated to the email on record from Authorize.net. This is the only receipt we generate. We accept MC/VISA/AMX. We do not accept debit cards or gift cards. Phone number in case we can’t reach you by email: ____________________________________ Credit card #:______________________________ Expiration date:_______________________ Signature:________________________________________________________________________ If paying by check, please make payable to The Montessori Foundation 935 N. Beneva Rd. Ste 609 #56, Sarasota, Fl 34232. All checks must be drawn on US funds. Below: Please indicate first and second choices for each session by placing a checkmark (✓) in the column next to the course title. 1st Choice
1st Choice 2nd Choice FRIDAY NOVEMBER 5 SESSION 1
FRIDAY NOVEMBER 5 SESSION 2
1 2 3 4 5 6 7 8
9 10 11 12 13 14 15 16
Leadership Unit 1/Seldin Inner Guide PT 1/Haskins Creating Partnership Peace PT 1/Leitch High School Best Practices/Cash APC/McGrath Community in One PT 1/Sweet & Langley All Kinds of Minds PT 1/Hites Nurturing Boy - Pt 1/Hoke
800-632-4121
2nd Choice
Leadership Unit 2/Seldin Creating Partnership Peace PT 2/Leitch Inner Guide PT 2/Haskins Self-Regulation/Johnson Community in One PT 2/Sweet & Langley All Kinds of Minds PT 2/Hites Nurturing Boy - Pt 2/Hoke Cosmic Café PT 1/Dorer
14th Annual Conference
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