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Conference Location:
Greektown Hotel and Casino
555 E. Lafayette Blvd.
Detroit, Michigan 48226
www.greektowncasino.com
Call Direct 877-424-5554
Indicate that you are with the Ford PAS Conference $139 per night, single/$144 double occupancy
ON-LINE REGISTRATION
Please Note Important Deadlines:
July 19 - September 15, 2010: $200
After September 15, 2010: $300
Answers are required for all fields with an asterisk (*) next to it.
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Please fill in your contact information below.
Please fill in your contact information below.
First name*
Last name*
Nickname or first name for badge*
Job title*
Organization/School Affiliation*
Hub Affiliation/Connection*
Work address*
City*
State*
ZIP*
telephone* (333-333-3333)
E-mail*
Choose the appropriate category.
Choose the appropriate category.
High School Teacher or other school staff
High School Administrator
Guidance Counselor
Representative of Higher Education
Representative of Community Based Organization
Representative of Business
Workforce Economic Development
Ford PAS TA Group
Other (please specify)
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I would like my name and email address to be included on a contact list for workshop participants
I would like my name and email address to be included on a contact list for workshop participants
Yes
No
*
Which event will you be attending?
Which event will you be attending?
Ford PAS Next Generation Learning Symposium: Part II - October 14-15, 2010
Ford PAS NGL Professional Development Provider Workshop (Invite Only) - October 16, 2010
Both
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work address
home address
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