PENN SACCA

2015 Statewide Conference Registration Form

November 13 & 14, 2015 ■ Holiday InnHarrisburg, Grantville, PA

Complete this form on your computer, save, and print.

Name / Phone
Agency / PA Keys Registry ID
Address / Email
City / PENN SACCA Membership #
State / Zip / County / # Children Served:
Position: DIR GS AGS Aide Other / Regional Key: NW SW SC NE SE

OST Involvement…indicate involvement or completion of any of the following:

(Check) / Program / Year / (Check) / Program / Year
ASQ / Afterschool Champions
Director’s Credential / Afterschool Ambassadors
SAPC / STEM Pilot
Accreditation (Type: ) / STAR #

Not a Comprehensive member of PENN SACCA? Join now and save…complete membership form( and include with Conference Registration.

Registration Fees Enclosed for This Registrant (includes continental breakfast, lunch and materials)

COMPREHENSIVE MEMBER PRICES / REGULARNON-MEMBER PRICES
Day(s) Attending / EARLY BIRD SPECIAL
Received by October 15th / Regular Price
After October 15th / Not sure if you are a current member? Contact Connie Morak at
Friday (11/13/15) only / $100 / $115 / Friday (11/13/15) only / $200
Saturday (11/14/15) only / $100 / $115 / Saturday (11/14/15) only / $200
Both Days / $190 / $220 / Both Days / $400

Workshop Registration– indicate your 1st and 2nd choice for both AM and PM sessions by checking appropriate box

Friday AM Session
9:00 am – 12:00 pm / 1st Choice / 2nd Choice / Friday PM Session
1:15 pm – 4:15 pm / 1st Choice / 2nd Choice
1 / Emotional Intelligence for OST / 4 / Social Intelligence for OST
2 / PA Keys: SAC Initiatives / 5 / I Can Problem Solve
3 / Engineer Your SE Learning / 6 / The 6 “P’s” of Marketing OST

Session 3:I will be attending the Friday Evening Session-It’s all About Connections! & Reception

Saturday AM Session
8:00 am – 10:00 am / 1st Choice / 2nd Choice / Saturday AM Session
10:15 am – 12:15 pm / 1st Choice / 2nd Choice
8 / Activities-Children Experiencing Loss / 13 / Creating Positive Environments
9 / Intra-Personal Social Skills / 14 / Inter-Personal Social Skills
10 / Building Positive Connections / 15 / Grief Matters
11 / Implementing PTA Standards / 16 / Danger-Single Story
12 / Links to Learning (Part 1)Add 2 &3 / 17 / Links to Learning (Part 2)Add 3

Saturday PM Session
1:45 pm – 3:45 am / 1st Choice / 2nd Choice
18 / Improv Techniques
19 / Helping Children Learn Self-Control
20 / A Sense of Belonging
21 / Encourage the Heart
22 / Links to Learning (Part 3)

You can also register online @

PAYMENT & REGISTRY ID MUST ACCOMPANY REGISTRATION