Seminars on Inclusive Assessment

Alexandria, Virginia
October 24th and 25th

Sheraton Suites Alexandria
801 North Saint Asaph Street
Alexandria, VA 22314
Phone (703) 836-4700 Fax (703) 549-8758

Seminar Registration Fee: $130.00 per person

Extended Seminar Registration Deadline: Tuesday, October 17, 2006

***Before completing the registration below, please call the hotel at the number above to check on room availability and to make your own room reservation. We will do our best to work with the hotel to extend the conference room rates.***

Please complete the online registration form below for each participant (a separate form must be submitted for each participant from your state) and indicate your method of payment. Or, print out the registration form and fax your form to Carol Burkhart at 415-615-3200.

Note: Registration is on a first come, first served basis and is limited to 90 participants. Registrations will not be accepted once this limit has been reached.

Participant Registration

*Required fields.

Please complete a separate registration form for each individual on your team.

First Name *	Last Name *	Title *
Region * Alaska Comprehensive Center Appalachia Regional Comprehensive Center California Comprehensive Center Florida & the Islands Regional Comprehensive Center Great Lakes East Comprehensive Assistance Center Great Lakes West Comprehensive Assistance Center Mid-Atlantic Comprehensive Center Mid-Continent Comprehensive Center New England Comprehensive Center New York Comprehensive Center North Central Comprehensive Center Northwest Regional Comprehensive Center Pacific Comprehensive Regional Assistance Center Southeast Comprehensive Center Southwest Comprehensive Center Texas Comprehensive Center Other
State Department of Education/Division or State you are representing *
School/Organization Address *
City *	State * Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming	Zip *
Email *	Phone	Fax
Meal Would you prefer a vegetarian lunch? Yes
Special Accommodations Do you need any special accommodations? If yes, please specify:
Conference Registration Fees Seminar Registration Fee: $130.00 per person (two breakfasts and one lunch included).
Payment Method * Check PO Credit Card
If paying by check, please enter check number.
If paying by purchase order, please enter PO number. (If more than one team member will be paid by PO, enter the PO number on each person's registration.)
Please make checks and purchase orders payable to WestEd. Payments must be sent to WestEd, attention Carol Burkhart, at 730 Harrison Street, San Francisco, CA 94107.
If paying by credit card, you will be directed to a secure server at WestEd to enter that information on the next screen. Please have your card ready.