Catherine Woolf Student Leadership Conference 2010 Registration Form

Response Form for Student Leadership Conference

Reservations for the Catherine Woolf Student Leadership Conference are on a first-response basis.  Please note that this is program fills to capacity quickly. You will receive confirmation of your reservation by email when this form is received by the Holocaust, Genocide & Human Rights Education Center (HGHREC). If you do not receive a confirmation email within 5 days of submitting your registration form, it means you are not yet registered:  Please contact nsherman@brookdalecc.edu

Please indicate which day your school will participate in the conference and which teacher(s) will be accompanying the students. Students attending must have at least one teacher participating. Please return this form to HGHREC by January 14, 2010.

Please check off one:

School Name: _________________________________

will______ participate in the Student Leadership Conference on Thursday, March 18, 2010.

 will______participate in the Student Leadership Conference on Friday, March 19, 2010.

 
If my selected day is fully booked, please schedule my students for the alternate day
Yes___________             No___________

The following teachers will accompany the students (please print clearly):

________________________________________________________________________

Payment Information

Cost of conference is $10.00 per person.  Please make checks or purchase orders payable to HGHREC Education Center/BCC, 765 Newman Springs Road, Lincroft, New Jersey 07738

If using a school purchase order, please indicate the number_______________. Purchase orders are due one week prior to the conference date.

Contact Teacher should please complete the following:

The best ways to reach me by mail, phone and email are:

Street Address:_________________________________________________________

City, State, Zip:_________________________________________________________

Phone:________________________________________________________________

Email:________________________________________________________________

When other teachers have been invited, I will consult with them in choosing our student participants.  I understand that I will provide the names of the students to HGHREC when requested prior to the conference.

_____________________________________________
Signature