NAEYC REGISTRATION

Printable registration

First Name:
Last Name:
Home Address:

City:
State:		Zip:
Home Phone:		Work Phone:
E-mail:		Fax:
Best time/method to contact:
Name of Company:
Number of Children served
Ages of Children served

Type of Center	Non-profit	Public
	Head Start	Private
	Other

CEU	Yes, I'd like CEU credit (There is an additional $10 processing fee to receive a CEU)
Cost ........................ $45 Cost with CEU ...... $55
	Credit card (please call to give credit card information)
	Please Bill, PO (please mail or fax)
	Check (please mail)
	Toll free number: 800-554-PLAY (7529) Fax: 319-273-7308 Mail: NPPS University of Northern Iowa Human Performance Center 103 Cedar Falls, IA 50614-0618

NOTE: Since this is an interactive workshop with a field trip, space is limited. Therefore, no full refunds will be given for cancellations after November 11, 2009.Substitutes are welcome. Payment must be made at time of registration.