NCPN Online Registration Form

This form is only for attendees who are prepared to apply and pay for their registration online
today using a credit card or Paypal account.

To pay by check, please download this printed version and mail along with your check to
Linda Locke, Registrar, P.O. Box 21689, Waco, TX 76702-1689
llocke@cord.org or call 254-741-8334.

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

NOTE: To fill out the secure online forms you must be using one of the
following browsers or the form will not submit properly. Chrome version 33 and up, Android 5.0-5.0.2 and up, Firefox version 34 and up, IE 11 and up, Opera 17 and up , Safari 7 and up

(required fields are marked with an asterisk)
* First Name: 
* Last Name: 
* First Name for Nametag: 
* Job Title: 
* Organization: 
* Address 1: 
Address 2: 
* City: 
* State or Province: 
* Zip: 
* Country: 
* Phone Number: 
    Ext: 
* Fax: 
* Participant's E-mail: 
 
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, Wednesday, October 5
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 or the Employer Workshop.
Half-Day Preconference Workshops: 9:00 a.m. to Noon
Select one of the following..... 		Rate $ Amount
  Are You Certified: The Role of Industry Certifications and Credentialing
$125
$
  Employer-Education Partnerships: What are the Ingredients of a Winning Collaboration? (Includes lunch)
$125
$
  How Does Perkins and Adult Education Fit Into the WIOA Puzzle
$125
$
  Blended Learning: A Hands-On Approach to Building Technology-Infused Lessons
$125
$
  I will not be attending a workshop during this time period (Select this to deselect other options in this group)
 
 
Half-Day Preconference Workshops: 1:30-4:30 p.m.
Rate $ Amount
  Advancing Career Pathways for Adults: Building a Solid Foundation for an Effective System
$125
$
  Entrepreneurship
$125
$
  NCPN Leadership Development: Learning Today to LEAD Tomorrow
$125
$
  Flipped Instruction: A Guide to Create, Collaborate, and Engage
$125
$
  I will not be attending a workshop during this time period (Select this to deselect other options in this group)
 
   
 
Full-Day Preconference Workshops: 9:00 a.m. - 4:30 p.m. (includes lunch) Rate $ Amount
   Career Pathways Leadership Certification
$250
$
   Indiana-focused Career Pathways Leadership Certification
$250
$
   Ohio-focused Career Pathways Leadership Certification  
$250
$
  Counseling in a Career Pathways System
$250
$
  Supply Chain Management and Logistics: How to develop and sustain a successful program
$250
$
  I will not be attending a workshop during this time period (Select this to deselect other options in this group)
 
   
 
Fees for Main Conference, October 6-7 (See agenda.) (Fee includes membership)
   
Early Bird (deadline 7/20) $560 $
Preregistration (7/21 through 9/22) $590 $
Onsite Registration (after 9/22) $620 $
     
 
*I plan to attend the Member Lunch: Yes No  
Spouse (includes exhibit events only)     $60 NA $
Spouse Name:  

* Total Payment:

$  

Method of Payment:  (Tax ID # 74-2077794) (online registrations MUST be accompanied by credit card payment. If paying by check, registration must be mailed.

(click here for W-9)

*I understand that payment must be completed for this registration to be processed.