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Educators Ag Institute Registration

Contact Information


Gender
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First Name
(as it appears
on credit card)*
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Last Name
(as it appears
on credit card)*
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Name for nametag
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Email*
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Billing Address*
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(address associated with your credit card)

City
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State
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Zip
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Telephone*
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County*
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School or Organization*
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Grade Level You Work With*
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State Conference Attendance*

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If returning, year/years attended state conference
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National AITC Conference
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Sponsorship Information


I have a sponsor*
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Sponsor Name
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If you do not have a sponsor, we will work to secure
a sponsorship for you.


Administrative Information


How did you hear about our program?
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Special Needs or Dietary Requirements
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Continuing Education Information


Credits you wish to apply for:

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25-30 Act 48 hours for attending all workshops during the program week. An additional 5 Act 48 Hours can be earned by attending all workshops and submission of two lesson plans
to Educator's Ag Institute Director.


(We will send information only to those wanting graduate credits.) PSU fees for credits are the responsibility of the participant. PSU requires you to participate in all sessions and tours during the conference in order to get 1 or 2 credits. PSU requires you to fully participate and submit 10 lesson plans
to get 3 credits.

Your PPID No.
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Housing Information


Reservations and roommate assignments will be made for participants.
Rooms will be on a master bill.
Participants are responsible for incidentals.
Housing Options*

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Roommate's Name
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Please note:
- If you are commuting, please be aware - buses will leave at assigned times.

- If you wish to have a private room, you will be responsible for ½ the room charge,
$34.50 per night, which will be payable after the conference.


Participation Agreement and Fee Information


I have read and understand the guidelines for participating in this conference and agreement to this statement is my signature.
Required*
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$150 registration fee is required to complete registration
at the end of this form.

All registration forms and payments must be received before June 9, 2017
(This is the responsibility of the participant and is nonrefundable after June 9, 2017.)

SPACE IS LIMITED

Registration fee must be paid prior to receiving sponsorship assistance.

$750 workshop fee - If you are committed to attend,
we will work to find a sponsor to cover your $750 workshop fee.
Sponsorships are awarded in accordance with the sponsoring organization’s instructions and on a first-come-first-serve basis.

After registering, you will receive notice via email when our website
is ready for you to select your classroom sessions & tours.
Selections will be on a first-come-first-serve basis
.


 
Educators Ag Institute Registration Payment
Please note:
Your transaction is being processed on a secure server.

As we are a non-profit, please consider adding $1 to 3 to your total to help the Pennsylvania Friends of Agriculture Foundation pay the processing fee.

Credit Card Information

Accepted Cards: VISA, MasterCard, American Express
Registration Fee *
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DonateToward Our Processing Fees? (optional)
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Total Charge
0.00 USD

Card Number*
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Card Security Code (CSC)*
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Card Expiration*
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Card Expiry Year*
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