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Please print this page (or this Word document), fill it out, and send it (with payment, if not a student).

If you are a student, the conference is free,
but please REGISTER ON-LINE (so we can order food for you).


Name __________________________________ Email ________________________________________

Address _______________________________________________________________________________

Phone(s): Home: ___________________ Work: ____________________ Cell: ______________________

Affiliation ______________________________________________________ Student? [__] yes [__] No

Any special needs? _______________________________________________________________________


If not a student, please include payment (made out to "University of Hartford") with this Registration form:
$20 before Nov. 1,
$30 on Nov. 1 and later or at the door
No charge for students with an ID.

Date: _________________________

Send this form (and payment) to Donn Weinholtz (860-768-4186, weinholtz@hartford.edu)

Donn Weinholtz
ENHP Educational Leadership
223 Auerbach Hall
University of Hartford
200 Bloomfield Ave.
West Hartford, CT 06117