1. Register Early 
   Register by June 1, 2011, to save up to $25 on your conference fee.
2. Save When You Send a Team
   Receive a 10% discount when three or more participants from one institution register. 
3. Professional development
   Hours will be awarded to participants attending both days. Diocese of Rochester educators may also apply for ACT Certification.
4. Order additional classroom sets of posters and Workbook (correlates with Marc Brackett’s presentations at $30 each.
5. Scholarships
   Available by contacting ekirst@warner.rochester.edu.
6. Title Funds
   Title II-A funds for professional development under the No Child Left Behind Act may be available to attend the Institute.
7. Registration Confirmation
   The Warner School will e-mail a confirmation within one week after receipt of registration.
8. Registration Deadline: June 15, 2011
   

Substitutions and Cancellations
Substitutions are permissible up to five days before the Institute, but you must notify the Director by fax, e-mail, or mail.  Cancellations must be requested no later than June 30, 2011.  There will be a $50 administrative cost for cancellations.

Institute Program Changes
The Institute reserves the right, without having to refund any monies to participants, to make changes in its program, schedule, location, and/or presenters.

(1) Registration Data:

Name ________________________________________________________________________
(for your name tag)       

School District/Org. ____________________________________________________________

Title __________________________________________________________________________      

Address ______________________________________________________________________

City ___________________________________   State _____________      Zip ___________   

Is this address:   work ___      home ___

E-mail ________________________________________________________________________    

Work Phone  ___________________________________________________________________

Home Phone ___________________________________________________________________

(2) Registration Fees: Check ( X ) sessions you wish to attend:
Registration fees include breakfast, lunch, and appropriate breaks.

July 7, 2011                               July 8, 2011
AM Session A__    B__   C__    AM Session D__    E__    F__
PM Session A__    B__   C__    PM Session D__    E__    F__

One Day: July 7 ..............................................................$125. ________________

One Day: July 8 ..............................................................$125. ________________

Both Days........................................................................$225. ________________

After June 1, 2011............................................................+$25. ________________

My registration is part of a group of 3 or more: deduct 10%........... ________________

Each additional set of bullying materials...__________________ x$30. ________________

TOTAL...................................................................................... ________________

(3) Payment:
Registration fees, made payable to the University of Rochester, must accompany this form.
Fees are payable to:
MasterCard _____ VISA ___    

Check ____   Purchase Order (Title Funds) ____

Billing Address __________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________
     
     
     
Card No.  _______________________________________________________________________

Exp. Date ______________________________  3 Digit Security Code ___________________     

Signature

_______________________________________________________________________________

Send this page by June 15, 2011 to:
By Mail: Summer Institute/Warner School of Education, University of Rochester
Dewey Hall 2-143A, Box 270425, Rochester, N.Y.  14627-0425

By Fax:  Summer Institute/Warner School of Education (585) 473-7598

For More Information:
For questions about registration or the 2011 Summer Institute on Catholic Education, please contact Evelyn J. Kirst, Director, at (585) 273-2280 or by e-mail at ekirst@warner.rochester.edu.