TFA Annual Conference
Registration Form

Please use one registration form for each individual registering.
Individual membership is required to receive membership discount rates. Registrations must be received by September 21. After this date, a $35 registration fee will be added to those fees listed below. Cancellations will be refunded in full less a $45 processing fee for all cancellations received prior to September 21. After this date, refunds cannot be made. All no shows will be billed.

Please provide the following contact information:

Name

Organization

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Work Phone

FAX

E-mail

Registration Fees (please check one):
(included with registrations: all conference materials; concurrent sessions Friday/Saturday; opening reception Thursday; breakfast Saturday; Banquet Saturday)

Special Workshops:

1.  Sexually Reactive Children/1-2 Mbr = $100		2.  Sexually Reactive Children/3+ Mbr = $75
3. Sexually Reactive Children/1-2 Nonmbr = $150       4.  Sexually Reactive Children/3+ Nonmbr = $125  
5. The Missing Curriculum/1-2 Mbr = $225         	6. The Missing Curriculum/3+ Mbr = $175
7. The Missing Curriculum/1-2 Nonmbr = $255    	8. The Missing Curriculum/3+ Nonmbr = $225
9. Cognitive Behavior Modification/Mbr = $0		10. Cognitive Behavior Modification/Nonmbr = $100
11. TFA Support System (Mbrs only) -Administration	12. TFA Support System (Mbrs only) - Evaluation    
13. TFA Support System (Mbrs only) - Consultation	14. TFA Support System (Mbrs only) - Training

Social Program/Extra Tickets

1.  Administrators Facilitated Luncheon (1/2) =  $40  2.  Administrators Facilitated Luncheon (3+) = $30    3. Southfork Ranch Banquet Tickets (1/2) = $70        4. Southfork Ranch Banquet Tickets (3+) = $60

Certification Workshops (you may register for 2):

Certification Reviewer Training
Certification Application Training

Is this your first TFA Conference?

Yes No

Are you a Vegetarian?

Yes No

Payment Type:

Please provide the following billing information:

BILLING

Credit Card

Cardholder Name

Card Number

Expiration Date

Name
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail

	BILLING
Credit Card
Cardholder Name
Card Number
Expiration Date

TFA Annual Conference Registration Form

TFA -- RETURN TO HOME PAGE. Revised: November 13, 2002

TFA Annual Conference
Registration Form

TFA -- RETURN TO HOME PAGE.

Revised: November 13, 2002