NOTE: This form cannot be completed online.  Please print, fill out and mail to the address listed at the bottom of the form.  Thank you!


Registration Information:

  

Registration Information:

 

Please check a box below to register:

 

Yes, I want to attend the ATN Special Events: Enclosed is my $15.00 Pre-Registration fee, (postmarked by Monday, October 26, 2009), which includes membership, workshop participation, and reception.

 

$10.00 Pre-Registration for Students & Seniors (65+)

 

I cannot attend the Special Events, but I want to join ATN. Enclosed is my $15.00  

          check.

 

Please make all checks payable to “Radford University – ATN”

*Please note - $5.00 additional for on site registration.

 

The performance will be held in Preston’s Bondurant Auditorium at 1 p.m. on Saturday, November 7, 2009.

The workshop will follow and will be conducted in Peters Hall, Albig Studio.

 

Attendees qualify for teacher re-licensure points.

 ATN is a membership-based organization, so we need your financial support.

 

Name:

 

Address:

 

City, State, Zip

 

Home Phone:

 

Email:

 

Work place:

 

Work phone:

 

Subject and Grade taught:

 

School or Institution:

 

Are you an AASIS Mentor or Teacher?

 

 

Send to

Kerri Huff, ATN 

Box 7014, Appalachian Regional Studies Center

Radford University

Radford, VA 24142

Call (540) 831-5366 or FAX (540) 831-5951

Email:  khuff@radford.edu

Visit our Website: www.radford.edu/arsc

 


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