NOTE: Only 1 form needed per institution
Please fill in the appropriate details and submit using one of the following methods by October 6, 2017:
2580 275th Street
Washington, IA 52353
*Mailing registration with payment is preferred method; onsite payments will no longer be accepted.
2) E-mail (mail payment in): Oswald, Dana OSWALDD@wmpenn.edu
3) Fax (mail payment in): 641-673-1041
Note: Walk-ins are welcome and will be billed the total conference fee of $50, but materials/meals may not be available.
Name of Institution:
Persons Attending October 19:
Persons attending October 20:
Persons attending both days:
Two-day attendance$50 x _____________ =_______________
One-day attendance$30 x _____________ = _______________
Total Due: _________________
Please make checks payable to IACTE
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