Superintendents Retreat: Reflecting, Inquiring and Sharing

Superintendent's Retreat: Reflecting, Inquiring and Sharing June 24th and 25th, 2013 Nance Room, Longwood University, Farmville, VA

Registration Fee: $150.00 per registrant. This fee includes the cost of registration, meals, outings and parking.

Please note that Region 8 Superintendents have a special reduced price of $75.00.

Deadline to register is June 10, 2013 and payment must be received by June 20th.

To pay for the Superintendent's retreat, please complete this form then click on the "I Want to Pay Using My Credit Card" link below or submit all check payments to

Longwood University Office of Cashiering

201 High St

Farmville, VA 23909

*Checks must be made payable to Longwood University and a print out of this registration form MUST be submitted with the check payment*

NO refunds will be given after June 19, 2013. If you have registered and can not attend, please notify us by Wednesday, June 19 at 4:00 p.m. to cancel your registration and not be charged the registration fee.

*** For office use only: Banner Fund 11002 - E & G Deferred Revenue, Banner Account 22052 - Deferred Revenue - Education Workshops, Detail Code 1427 FRS 0-10000-2464 ***

* 1. Please provide full name of registrant.

* 2. What is the name of the School Division or Organization of the registrant?

* 3. Please note if the registrant is Region 8 Superintendent.

* 4. Please advise which special outing you plan to attend.

* 5. Please name a person we can contact for questions.

* 6. Please name the title of the Contact Person.

* 7. Please list the contact's mailing address.

* 8. Please list the contact's phone number.

* 9. Please list the contact's email address.