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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

$75


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.

$25


Georgia FFA Alumni Association

$15


GACTE/ACTE

$115


NAAE Legislative Fund

$10


Agricultural Education Magazine

$10


GVATA Flower Fund

$3


The Council

$2


Ft. Valley State University Alumni Dues

$25


GVATA PRC *

$150
$200
$250
I choose not to contribute at this time ($0)
Other:


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
registration.



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