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GVATA 2013 Summer Conference Registration

Please type all fields with correct capitalization as responses will be
used to generate invoices and receipts.

First Name *

Last Name *

School *

School System *

Ag. Ed. Area *

School Mailing Address * street or PO Box

School City *

School Zip Code *

School Phone * 123-456-7890

Superintendent Name

Principal Name

CTAE Director Name

Home Mailing Address * Street or PO Box

Home City *

Home Zip Code *

Home Phone 123-456-7890

Cell Phone 123-456-7890

Non-School Email This will be used for PRC messages

Number of Years Completed * as of July 1, 2013

GVATA/NAAE Professional Dues


Conference Registration

$75 (member registration)
$150 (non-member registration)

Lunch Guest This is for guest of conference registrants. Lunch (on Monday)
is part of the conference registration for all GVATA members.


Georgia FFA Alumni Association




NAAE Legislative Fund


Agricultural Education Magazine


GVATA Flower Fund


The Council


Ft. Valley State University Alumni Dues



I choose not to contribute at this time ($0)

GA FFA Foundation Donation

NAAE Ag Educators' Relief Fund Donation

Method of Payment * *Checks should be postmarked by July 1, 2013. After
July 1, please plan on paying at summer conference.

School Check
Personal Check
Credit Card (will include $9 processing fee, a PayPal invoice will be sent
to your PERSONAL email)

T-Shirt Size * All teachers will receive a t-shirt as part of their

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