REGISTRATION FORM

The Washington School Counselor Association 2015 Conference

"Vision, Focus, Change, Rejuvenate" February 24th-February27th, 2015

Doubletree Hotel and Conference Center, 18740 International Blvd, Seattle, Washington 98188

Last Name______First Name ______Contact Phone ______

Address ______City ______St. _____ Zip ______

Email ______

Hotel Information: The Conference is being held at the Doubletree Hotel and Conference Center, Seattle, Washington. A special WSCA conference hotel room rate of $137 government per diem for a single,or double, room can be obtained by calling 1-800-hiltons and requesting the Washington School Counselor Association Conference (WSCA) rate. To receive this rate you MUST book your room by February1st, 2015 the earlier the better as we have a limited amount of rooms available at the WSCA rate.

PRE CONFERENCE REGISTRATION FOR Tuesday, February 24th
Effective School Counselor Supervision Dr. Cher Edwards 9a.m.-4p.m. / Early Rate Jan 31, 2015 / Full Rate Feb 1, 2015
Members / $135 / $175
Non Members / $185 / $195
½ Day Pre Conference Wednesday February 25th
Networks for Life- This class fulfills the state requirement for suicide prevention training. / Early Rate Jan 31, 2015 / Full Rate February 1, 2015 / Choose Am or PM
Circle one
Members / $65 / $95 / 9a.m. - Noon
Non Members / $95 / $105 / 1p.m. -4p.m.
PRE CONFERENCE REGISTRATION FORWednesday, February 25th 9a.m.-4p.m. / Early Rate Jan 31, 2015 / Full Rate Feb 1, 2015
Members / $135 / $175
Non Members / $185 / $195

Please choose a pre-conference below.

___Pre-conference 1-Enhancing Intrinsic Motivation to Change and Achieve- Dr. Kathy Biles, and Dr. Gene Eakin

___Pre-conference2-Working with Students with disabilities: How to navigate Special Ed and Section 504 to deliver effective strategies-
Rebecca Ballbach and Jan Bakken, Special Ed. Director in Everett Public Schools

___Pre-conference 3-Using Data to Build and Drive the Response to Intervention Process- Dave Forrester and Dr. Tim Poynton

___Pre-conference 4- School Counselors as Mandated Reporters- Dr. Cher Edwards

REGISTRATION FOR
Thursday February 26th and Friday, February 27th /
Early
Jan 31, 2015 / Full Rate
Feb 1, 2015
WSCA Member / $215 / $255
Nonmembers / $295 / $325
**Renew my membership- Professional / $50 / $50
Student or Retired members / $155 / $175
**Renew my membership-Student or Retired / $25 / $25
Student/Retired Nonmembers / $195 / $205
Presenters / $195 / $225
Principals / $205 / $245
One-Day-Members, please circle one Thursday or Friday / $140 / $165
One Day-Non Members, please circle one Thursday or Friday / $175 / $195
One-Day-Student Members, please circle one Thursday or Friday / $90 / $105
One Day-Student Non Members, please circle one Thursday or Friday / $120 / $135

Students: School you are enrolled in ______, and have a professor sign here ______.

Note:If you are paying a nonmemberrate and are registering for theThursday February 26th and Friday February27th and would like a complimentary membership to WSCA for a year please check here _____.

General Information: The Pre-conference lunch is on your own February 24th and 25th. Lunchis included in the price for the full conferenceFebruary 26th and February 27th. Conferencecancellations are allowed but must be in writing to the conference coordinator and postmarked prior to FEB 1, 2015. There is a $50 processing fee for cancellations. The hotel charges for parking$7.00 per day or $10.00 overnight.

SPECIAL NEEDS- To insure proper accommodation of special needs, WSCA will need to know of any special needs requests by February 1st, 2015.

**WSCA members can now renew your membership with conference registration.

______.

Clock Hours, CEU’s, and credit hours fromSU are available. Clock hours available are 6 hours on 2-24,6 hours on 2-25,
6.5 on 2-27 and 2-28Total available clock hours are 25 for all four days.

Payment: My Total Amount is ______My payment is by: ___ Enclosed Check Checks and P.O. payable to WSCA

___ Purchase Order # ______dated ______From ______

___ Please Charge My: __VISA ___ MasterCard __Am Express

credit card number #______
Expires ______CSV Code from the back of the card _____ Signature ______

Please send this form to: Chris Kelly, Conference Coordinator, 8322 110th St. East, Puyallup, WA98373

Questions? Call Chris Kelly at (253) 445-0541, fax 253-445-6114, or email