Registration FormNew YorkState Reading Association Annual Conference

Monday, November 9 to Wednesday, November 11, 2015 The Saratoga Hilton & Convention Center, Saratoga Springs, NY

Last Name: First Name:

Address:

City: State: Zip Code:

Home Phone: Business Phone:

Affiliation: Position:

Valid E-Mail (REQUIRED):

Are you a current member of New York State Reading Association?  YES  NO If yes, which local council?

REGISTRATION FEES AND OPTIONS (PER PERSON) / REGISTRATION TOTALS AND PAYMENT INFORMATION
 $40 NYSRA AT-LARGE MEMBERSHIP (If you aren’t already a member, selecting this option qualifies you to take the Reduced Conference Member Rates.)
SPECIAL NYSRA MEMBER ONLY EARLY BIRD RATES (PER PERSON)
(MUST Be Postmarked Before October 1, 2015)
MEMBER SPECIAL RATES
 / Members Only Early Bird Rate- Full Conference Only ( Savings of $30) / $245
REGULAR COMFERENCE RATES (PER PERSON)
(MUST Be Postmarked Before October 31, 2015)
MEMBER ONLY RATES
 / Full Conference Members (includes Wednesday Lunch*) / $275
 / Monday or Tuesday Members(Per Day)
Please check day(s):  Monday  Tuesday / $100
 / Wednesday Members (Includes Lunch*) / $100
NON-MEMBER RATES
 / Full Conference Non-Members (Includes Wednesday Lunch*) / $325
 / Monday or Tuesday Non- Members(Per Day)
Please check which day(s):  Monday  Tuesday / $150
 / Wednesday Non-Members (Includes Lunch*) / $150
SCHOOL GROUP RATES- PER PERSON (For groups of 3 ormore from a single school district. MUST submit all registrations together. NYSRA membership is not required to use this rate.)
 / Full Conference (Includes Wednesday Lunch*) / $200
 / One Day(Per Day)
Please check day(s):  Monday  Tuesday  Wednesday / $100
For large school group rates, please contact the registrar for additional rates.
STUDENT RATES (Full time student. MUST attach a current letter from the College or University to verify full time student status.)
 / Full Conference (Includes Wednesday Lunch*) / $100
 / Monday or Tuesday(Per Day)
 Please check which day(s):  Monday  Tuesday / $30
 / Wednesday (Includes Lunch*) / $55
For large group student rates, please contact the registrar for additional rates.
SPECIAL TICKETED EVENTS (PER PERSON)
SPECIAL TICKETED EVENTS RATES
 / Monday Author Lunch—Teachers as Authors / $36
 / Tuesday Author Lunch—Informational Text / $36
*IMPORTANT
 Please check here if you DO NOT plan to attend the Wednesday Lunch.
Please check here to indicate special dietary needs. We must be informed by Oct. 31, 2015.
Special Dietary Needs: / REGISTRATION TOTALS
MEMBERSHIP FEE SUBTOTAL$
REGISTRATION FEE SUBTOTAL$
SPECIAL EVENTS FEE SUBTOTAL$
TOTAL AMOUNT DUE$
FORM OF PAYMENT (Full payment must accompany this form.)
 Check # Amount: $
Name on Check:
 Money Order # Amount: $
 Purchase Order #______
District: ______
(We will invoice the district for the amt. due when paying by PO.)
 Credit Card Card Type:  VISA  MasterCard  AMEX
Card Number:
Name on Card:
Expiration Date:
Billing Zip Code:
Security Code from Back of Card:
Signature: Date:
(NYSRA reserves the right to charge your credit card the correct amount if there is an error in the calculation of the amount due.)
Please Note: The NYSRA Federal Taxpayer ID Number is: 16-6098728
PLEASE MAIL or E-MAIL COMPLETED REGISTRATION FORM ALONG WITH METHOD OF PAYMENT TO:
NYSRA CONFERENCE REGISTRATION
c/o Mary & Larry Kline
507 Bretts Way
Whitesboro, NY 13492
For Registration Questions
Please E-MAIL Larry or Mary Kline at
Please check here to indicate that you will need a sign language interpreter. NYSRA must be informed by Sept. 1, 2015.
 IMPORTANT NOTICES/INFORMATION 
  1. A $25 late registration fee will be assessed for all registrations received after October 31, 2015 and for On-Site Registrations.
  2. Refunds will be made only for a written request postmarked by October 31, 2015.
  3. Registration Confirmation e-mail will be sent to the e-mail address listed above once the registration has been processed.
  4. For Hotel Room Reservations, please go to the Hotel Booking Website at Reservations for this group rate should be made on or before October 9, 2015.
  5. For NON-REGISTRATION QUESTIONS: Please e-mail the Conference Coordinator at .