TEST – Core Knowledge Foundation

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Registration Form

1. Registrant Information

Sweetheart of a Deal: Register 3 or more for $625 per participant

*Offer valid through 2/21; regular price $650 per participant

To add or remove participants, click the “+” or “-” below. If you have a participant(s) who will be presenting at the conference, their registration is free and should not be included in your total number of participants. Please add their name(s) to the “Presenter(s)” fields only.

Number of Registrants*

Registrant(s)*

First Name

Last Name

Position

Presenter(s)

First Name

Last Name

Name of Primary Point Contact*

Email of Primary Point Contact*

School / Organization Name*

School / Organization Address*

Street Address Address Line 2 City ZIP Code

CountryState

School / Organization Phone Number*

Consent*

(This agreement applies to all registrants and presenters on this form.)

I hereby consent to the taking of photographs or videos of me by the Core Knowledge Foundation (CKF), whether by an authorized representative of CKF, or an Independent Contractor hired by CKF. I also grant to CKF the right to edit, use, and reuse said photographs or videos for any purpose, and in all forms of media including use in print and on the internet. I also hereby release CKF and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above.

2. Payment

Registration Total

Price: $3,000.00

Registration Total

Price: $3,000.00

Payment Type*

Credit Card

Purchase Order

Please make the check payable to the Core Knowledge Foundation. Mail to:
Schools Department
801 East High Street
Charlottesville, VA 22902

Purchase Order Number*

The Purchase Order must be on file in order to guarantee a seat.

Upload Purchase Order*

Max. file size: 2 GB.

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

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Subtotal

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country