NCPN Online Registration Form

Step 1 of 3 - Enter your information below then click the "Continue with Registration" button.

(required fields are marked with an asterisk)
* First Name: 
* Last Name: 
* First Name for Nametag: 
* Job Title: 
* Organization: 
* Address: 
* City: 
* State: 
* Zip: 
* Country: 
* Phone: 
* Fax: 
* E-mail: 
How did you hear about this conference: 
Select the area that best describes your work:
K-12      Postsecondary       Adult Education      Workforce Development      Employer       Other
Also, if in education, choose one of the following:
CTE Faculty       Academic Faculty         Counselor /Advisor       Local/Regional Administrator/Coordinator     State/Federal Administrator/Coordinator
Other  
PRECONFERENCE WORKSHOPS, Sunday, October 13

Attendees can attend one full-day workshop or up to two half-day workshops (morning and afternoon).
Lunch is included for attendees of a full-day or two half-day preconference workshops.

Half-Day Preconference Workshops: 9:00 a.m.-Noon
Select One of the following.....
Rate Total Payment
   The San Antonio Model: A Unique Career Pathway Network $125 $
   Technology-Infused Classroom SOLD OUT $125 $
   I will not be attending a morning preconference.
Half-Day Preconference Workshops: 1:30-4:30 p.m.
Select One of the following.....
Rate Total Payment
   College and Career Readiness and Toolkits $125 $
   Technology-Infused Classroom (REPEAT) $125 $
   I will not be attending an afternoon preconference.    
Full-Day Preconference Workshop: 9 a.m.–4:30 p.m. (includes lunch)
Select One of the following.......(must not be registering for a half-day workshop)
Rate Total Payment
   Career Pathways Leadership Certification: STEM-Focused Version (must also attend main conference) SOLD OUT $250 $
   Career Pathway Effect Series: Counseling for Success $250 $
   Career Pathway Effect Series: Partnership Opportunities $250 $
   NACPL Forum: Education in the Workplace for Economic Prosperity (8:30am-4:30pm Cont. breakfast @ 8:00am)
$250 $
   I will not be attending a full-day workshop.  
Fees for General Conference, October 14-15 (See agenda)
  NCPN Member Nonmember Total Payment
Super Early Bird (deadline 6/30/13) $470 $510 $
Early Bird (7/1/13 through 8/31/13) $485 $525 $
Preregistration (9/1/13 through 10/04/13) $500 $540 $
Onsite Registration (after 10/04/13) $520 $560 $
ADDITIONAL FEES
NCPN Membership Fee (for new or renewing members) $75   N/A $
Nonmembers: Attend Members Lunch Tuesday N/A $40   $
If membership expires prior to 10/1/13, you must renew membership to take member discount. If joining on this form, please take member rate.
Spouse (includes receptions and exhibits only) $60 NA     $
Spouse Name:  
Discount for General Conference
Full-time Classroom Teachers Discount - Subtract $50
(does not apply to counselors)
-$50 NA -$

* Total Payment: 

Method of Payment (Tax ID# 74-2077794)
  Click here for W-9 Form.
PO #: 
Billing Organization: 
Billing Address: 
City: 
State: 
Zip: 
* Billing Phone: 
* Billing Email: 
Credit Card: 
  If paying by Credit Card, submit the form first, then call Teemus Warner, NCPN registrar, at 254-741-8337 between 8 am and 5 pm Central Time with your Credit Card number.
I understand that payment must be included for this registration to be processed and have included payment in the form of a purchase order or calling in with a credit card to cover my registration. If paying by check, registration must be mailed.