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