Making Connections

First Name:	Middle Initial:
Last Name:
Prefix/Title:	Dr. Mr. Ms.
Position:
District:
School:
Address:
City:
Zip Code:
A/C Phone:
Fax Number:
E-mail:	*Required

Please register me for the following session:
	June 10	Kentucky Dam Village State Park	Gilbertsville
	June 16	Nelson County Board of Education	Bardstown
	June 17	Holiday Inn University Plaza	Bowling Green
	June 24	Hazard Community & Technical College	Hazard
	June 26	Four Points Sheraton	Lexington
	July 8	OVEC Conference Room	Shelbyville
	September 25	Newport Ind. PD Center	Newport
Payment Options:
$125 for KASA Members / $150 for Non-members Purchase Order #
Check (Note: I've printed this form and mailed it with my check to 154 Consumer Lane, Frankfort, KY 40601)
All sessions have been approved for 6 hours EILA credit. Cancellation Policy: Written cancellation will be accepted until 48 hours prior to the date of the session. KASA reserves the right to cancel any workshop that does not have adequate participation.

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Wayne Young, Executive Director
Rhonda Caldwell, Deputy Director
Clyde Caudill, Legislative Liaison
Shirley LaFavers, Director of Professional Development
Wanda Darland, Communications Specialist

152 Consumer Lane
Frankfort, KY 40601
(800) 928-KASA or
(502) 875-3411

Fax (502) 875-4634