INVOICE # 166283

Registered By: Brian Daughtery (bdaughtery@forsyth.k12.ga.us)

Date 10/4/2017 3:13:13 PM Registration Amount $200.00
Amount Paid $200.00
Amount Due $0.00

GaETC 2017 REGISTRATION FORM

November 8 - 10
Georgia International Convention Center, Atlanta

 Confirmation/receipt will be sent by email.

 Name Badge will be mailed approximately 10 days prior to the conference to the Home/Mailing Address
entered below.
 Questions? Email gaetcreg@mcraemeetings.com or call 866-554-2382

PERSONAL INFORMATION REGISTRATION OPTIONS

Title: Please select a conference registration
type or code:

First Name: -Full Conference Registration $200.00

Last Name: Pre-Conference Workshops - Tuesday,

Nov. 7
Hands-on workshops are an additional fee of $75
Suffix: each if you have a Conference Registration. Note
that Workshop W2 Microsoft Academy is $150 if
you have a Conference Registration. To register for
a Workshop only without a conference registration,
WORK INFORMATION please contact Registration Management.

School/Organization: Note: Hands-on workshops are NOT included with a

Prepaid Code.

Work Addr1: Please enter the number of workshops

below and then select the workshop(s)
you wish to attend from the drop-down
Work Addr2: lists.
 PAYMENT INFORMATION
Work City: Cancellation Policy: All cancellations
and requests for refunds must be made in writing
and received by October 6, 2017. No refund
requests will be honored after this date, however,
Work State: substitutions may be made. Cancellation/Refund
requests may be emailed
to gaetcreg@mcraemeetings.com or mailed to the
address below. All cancellations will be subject to
Work Zip: an administrative fee of $30.

- I have read and understand the

Job Title:
cancellation/refund policy.

Please enter the name of your school district or N/A.

SELECT PAYMENT TYPE
School District:
Payment Method:
Purchase Order
13970
CONTACT INFORMATION
Please add or update info as needed. Name badge will be mailed to the address
entered below:

Email:

Day Phone:

Cell*:

Home Address:

Home City:

Home State:

Home Zip:

*For onsite emergencies and urgent conference messages only.

 OTHER INFORMATION
DEMOGRAPHICS (please check one box in each
category)

Position:
-Technology Directory/Coordinator/Specialist

Level:
-Secondary

Sector:
-Public Education

GENERAL INFORMATION

Please check all that apply:

-It is my FIRST TIME attending GaETC.