GVATA 2012 Summer Conference Registration

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Please type all fields with correct capitalization as responses will be used to generate invoices and receipts.

First Name *

Last Name *

School *

School System *

Ag. Ed. Area *

School Mailing Address *

street or PO Box

School City *

School Zip Code *

School Phone *

123-456-7890

Superintendent Name

Principal Name

CTAE Director Name

Home Mailing Address *

Street or PO Box

Home City *

Home Zip Code *

Home Phone

123-456-7890

Cell Phone

123-456-7890

Personal Email

This will be used for PRC messages

Number of Years Completed *

as of July 1, 2012

GVATA/NAAE Professional Dues

$75

Conference Registration

$75 (member registration)

$150 (non-member registration)

Lunch Guest

This is for guest of conference registrants. Lunch (on Monday) is part of the conference registration)

$25

Georgia FFA Alumni Association

$15

GACTE/ACTE

$115

NAAE Legislative Fund

$10

Agricultural Education Magazine

$10

GVATA Flower Fund

The Council

Ft. Valley State University Alumni Dues

$25

GVATA PRC *

$150

$200

$250

I choose not to contribute at this time ($0)

Other:

Required

GA FFA Foundation

Donation

NAAE Ag Educators' Relief Fund

Donation

Method of Payment *

*Checks should be postmarked by July 1, 2012. After July 1, please plan on paying at summer conference.

School Check

Personal Check

Credit Card (will include $9 processing fee, a PayPal invoice will be sent to your PERSONAL email)

Required

Submit

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