Registration Options:

Online: www.spedregistration.com
Phone: 801-957-5200 or 801-957-5201
Fax: 801-957-5328
Email: MillerEvents@slcc.edu
Mail: Salt Lake Community College
SPED Registration MPDC 110
9750 South 300 West Sandy, UT 84070

Registration Information:

Saturday, March 23, 2013

Cottonwood High School
Murray, Utah

No refunds will be issued once registered

No registrations will be taken at the door
Limited seating available, all sessions are first come first serve
Please DO NOT bring children to the conference
Registration Dates: Feb 11-28 Earlybird to Mar 1-8 Regular

Program/Center Name: ___________________________________________

First Name:______________________________________ Last Name:_________________________________
Home Address:______________________________________________________________________________________________
City: __________________________________________________ State: _____________ Zip Code:________________________
Personal Phone:______________________ Work Phone: _______________________
E-mail: ________________________________________________________ (required)

Registration Options:
Type of Program (Check All That Apply):
Session Options
UAEYC Member
Administrator
Center Child Care
Head Start/Early Head Start
Preschool
Early Intervention

After School
Family Child Care
Kindergarten Student
Primary Grade
Student

Please list your top four choices for each session you wish to attend

Session 1 -- 10:15am-11:15am
1________ 2________ 3________ 4________
Session 2 -- 12:15pm-1:30pm
1________ 2________ 3________ 4________

Conference Fee:
$20.00 Keynote only (no lunch or sessions)
$35.00 Early Bird full conf. (w/lunch) Feb 11 - 28
$45.00 Regular full conf. (w/lunch) Mar 1-8
Committee Member/Volunteer /Presenter: To Register, contact
Celia Duarte at 801-957-5312

Session 3 -- 1:45pm-3:00pm
1________ 2________ 3________ 4________
Session 4 2.5 Hour Session-- 12:15pm-3:00pm
If registering for Session 4, please do not register for Session 2 or 3.

1________ 2________ 3________ 4________

Total: $____________

Please select preconference events on Friday March 22, 2013 you plan to attend (no
additional fee). Show registration receipt for entrance.
I will not be attending preconference events
I plan to attend Night at the Museum event
I plan to attend Tours of NAEYC Accredited Programs
I plan to attend the Lakeshore Learning Workshop
For more information please visit:
http://www.utahearlychildhoodconference.com/p/preconference-events.html

Payment Options:

Credit Card

Visa

AMEX

MasterCard

Discover

Name on Card: ____________________________________

Card #: __________________________________________

Check/Money Order (Payable to Salt Lake Community College)

Business Personal Money Order
Check Date: ________________
Amount: ________________ Check #:______________

Expiration: _____________________ Security Code:_____

Credit Card Billing Address:

Purchase Order

________________________________________________
City:______________________ State: ______ Zip: _____
Phone #: _______________________
Signature: ________________________________________

#:__________________

Company Name: ___________________________________

Attn: ____________________________________
Phone: ___________________________________
Address: ___________________________________
City: ______________ State:_____ Zip:________

UAEYC may share its mailing lists with NAEYC and conference sponsors, check her to have your name removed

Registration provided by...

Office Use Only

Confirmation Sent:
Email Mail Fax In Person
Registered By:

Date: