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ReTgESiOsL 2t01r2 International Convention
Print This Form
Register Online Now
Registrant Information
TESOL Membership #: REGISTRANTS: Please read pages 30–31
of the Advance Program for registration policies
before completing this form.
Expiration Date:
Last (Family) Name:
First (Given) Name:
IMPORTANT: Registrations must be submitted or
postmarked by 11:59 pm EST* on 1 March 2012 to
qualify for the preregistration rate. Registrants
wishing to register at the member rates must hold
active membership in TESOL through 31 March 2012.
Middle Initial:
Mailing Address is: n Home n Office (please check one)
Institution or Company:
Mailing Address:
Register online at
City:State/Province:
Zip/Postal Code:
www.tesol.org/register/
Country:
Or mail or fax registration form to
Telephone:
TESOL 2012 Registration Services
c/o Showcare Event Solutions
1200 G Street NW, Suite 800
Washington, D.C. 20005-6705 USA
Fax:
E-mail:
Badge Information (please complete this section ONLY if this information is different from above)
Badge Name:
Institution/Company:
Tel. 866.999.3032 (U.S. and Canada)
Or +1 514.228.3074 (international)
Fax 866.614.5463 (U.S. and Canada)
Or +1 514.228.3151 (international)
E-mail [email protected]
City:State/Province:
Country:
Tell Us About Yourself
Are you a new member of TESOL?
n Yes n No
Are you a new teacher
(teaching 2 years or less)?
n Yes n No
1. Position (check all that apply)
■■
■■
■■
■■
■■
■■
■■
■■
■■
■■
■■
■■
■■
■■
■■
A. Full Time
B. Part Time
C. Student
D. Retired
E. Classroom Teacher
F. Professor
G. Dept. Head/Chair
H. Principal
I. Supervisor/Coordinator
J. Administrator
K. Student
L. Consultant
N. Director
O. Researcher
P. Other
Important:
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2. Institution/
Instructional Level
(check all that apply)
■■
■■
■■
■■
■■
■■
■■
■■
■■
■■
■■
■■
A. Pre-K
B. Elementary School
C. Middle School
D. Secondary School
E. 2-year/Community College
F. 4-year College
G. Graduate/Postgraduate
H. Business/Corporate
I. Nonprofit
J. Religious Institution
K. Adult Education Program
L. TESL/TEFL Certificate Program
3. Primary Area of Practice
(check only one)
■ ■ A. ESL/EFL Instructor
■ ■ B. ESL/EFL Educator
■ ■ C. ESL/EFL Education with some
Mainstream Instruction
■ ■ D. Mainstream with some
ESL/EFL Instruction
■ ■ E. Mainstream Educator
■ ■ F. Applied Linguistics
■ ■ G. Bilingual Educator
■ ■ H. TEFL/TESL Instructor
■ ■ I. TEFL/TESL Educator
4. Decision Making
■ ■ A. Recommend Products
and Services
■ ■ B. Identify Needs/Make Purchases
■ ■ C. Give Final Purchase Approval
■ ■ D. No Purchasing Authority
■ ■ E. Able to Hire/Make HR Decisions
5. Plan on Recommending/
Purchasing Products I see
at the Exhibition within
(check only one)
■■
■■
■■
■■
A. 0–6 Months
B. 7–9 Months
C. 10–12 Months
D. Not applicable
May TESOL provide your registration address to exhibitors and other interested educational organizations?
n Yes n No
Interpreter Services/Special Needs: Please contact Convention Services at [email protected] by 15 February 2012
about ASL interpreter services or other special needs.
B y submitting this registration form you are acknowledging that you have read and understand the registration, membership,
and cancellation policies of the TESOL International Convention & English Language Expo listed on pages 30–31 and 34
of the Advance Program.
TESOL International Convention & English Language Expo
*Click here to convert to your local time
Registration
Name of Registrant
Last (family) Name
First (given) Name
Telephone Number
A. Registration and Dues (check appropriate boxes below)
■■
■■
■■
■■
■■
■■
■■
■■
■■
1. Member Registration**
2. 2nd Member Registration from Same Institution
3. Member Group Registration**+
4. Nonmember Registration
5. Nonmember Group Registration+
6. Student Member**
7. Retired Member**
8. K–12 Preconvention Workshop
9. PCI Only**
Early Registration
Advance Registration
(on or before 1 February)
(2 February–1 March)
US$320
US $375
US $275
N/A
US $265
US $310
US $535
US $605
US $535
US$550
US $140
US $180
US $175
US$210
–see section B below–
–see section B below–
Dues
(C200)
$
$
$
$
$
$
$
Additional Dues
(C201)
$
$
$
$
$
$
$
Subtotal
$
$
$
$
$
$
$
Total A $
**If your membership expires on or before 31 March 2012, you must renew to remain eligible for the member registration
rate. Students must provide proof of full-time status upon registering. See page 34 for details about membership.
+A school or district is eligible for group rates if sending 5 or more attendees. All registrations included in the group
must be sent in at the same time. Minimum of 5 registrations must be received by 1 March.
B. Ticketed Events/Optional Fees
■ ■ Breakfast With TESOL’s Best — Please refer to page 28. US$45 each
Please indicate your first choice and alternates in the spaces below.
■ ■ K–12 Day Preconvention Workshop — Please refer to pages 24–25 for
workshop numbers. If you attend K–12 Day, you must choose a First and Alternate
workshop for every time slot. All workshops occur on Tuesday, 27 March 2012.
n Nonmember US$245
By 1 February: n TESOL Member US$215
n TESOL Member Group US$180 n Nonmember Group US$205
After 2 February: n TESOL Member US$270
n Nonmember US$300
Cost $
First Choice
[K-12 am] 8 am–8:45 am, Morning Keynote
[K-12 9:00 am A-G] 9 am–10:30 am
[K-12 10:45 am A-G] 10:45 am–12:15 pm
[K-12 pm] 12:15 pm–1:15 pm, Lunchtime Keynote
[K-12 1:30 pm A-G] 1:30 pm–3 pm
[K-12 3:15 pm A-G] 3:15 pm–4:45 pm
Alternate
n
Alternate
[T01–T08] Thursday
[T11–T18] Friday
Alternate
Cost
$
$
Cost
Total B $
+ Total * $
=
$
Payment Information
Please make check or purchase order payable to TESOL.
Alternate
Cost
$
$
$
$
$
■ ■ LDCP46
■ ■ LDCP47
Payment must be made in U.S. dollars. Checks will be processed electronically. If you do not want
your check converted electronically, please select another method of payment.
Check #
n Personal Check n Company Check
Purchase Order (See page 31) Send purchase orders and all registration forms to Showcare Event Solutions. Purchase orders must be postmarked by 1 February. Full payment for
purchase orders must be received by 15 March.
Purchase Order #
Credit Card: n VISA n MasterCard n American Express
credit card number
Expiration date
Registration
■ ■ Leadership Development Certificate Program (LDCP)— Please refer to pages 22–23
for workshop descriptions, times, and days. US$100 for entire program.
■ ■ [LDCP 1] First-time LDCP registrant (Strand 1)
$
■ ■ [LDCP 2] First-time LDCP registrant (Strand 2)
$
Includes 4 required workshops on 28 March 2012, 9 am–4 pm
■ ■ [LDCP Cont1] Continuing LDCP registrant Strand 1
$ 0
■ ■ [LDCP Cont2] Continuing LDCP registrant Strand 2
$ 0
■ ■ [LDCP Online] Continuing LDCP registration (online)
$ 0
Electives (Strand 1 and 2)
■ ■ LDCP40
■ ■ LDCP43
■ ■ LDCP41
■ ■ LDCP44
■ ■ LDCP42
■ ■ LDCP45
Cost
$
■ ■ Raffle Tickets+
# of tickets ordered
1 ticket = US $3, 3 tickets = US $7, 5 tickets = US $10
$
Total * $
By 1 February: TESOL Member US$125, Nonmember US$155
After 1 February: TESOL Member US$155, Nonmember US$185
Alternate
Cost
$
$
Half Day
Required Workshops (Strand 1)
■ ■ LCDP36
■ ■ LDCP38
■ ■ LDCP37
■ ■ LDCP39
First Choice
+All proceeds from the raffle support the TESOL Awards and Grants Program.
On-site pricing may be higher
By 1 February: TESOL Member US$175, Nonmember US$205
After 1 February: TESOL Member US$205, Nonmember US$235
First Choice
Cost
$
$
$
■ ■ Tea With TESOL’s Best — Please refer to page 29. US$45 each
[EV01–EV19] Wednesday
First Choice
Alternate
First Choice
n
Full Day
[PCI06–PCI10] Tuesday, 1 pm–5 pm
[PCI11–PCI14] Tuesday, 5 pm–9 pm
[PCI22–PCI25] Wednesday, 8 am–12 pm
[PCI26–PCI30] Wednesday, 1 pm–5 pm
[PCI31–PCI35] Saturday, 2 pm–6 pm
[B01–B08] Thursday
[B11– B18] Friday
[B21–B27] Saturday
■ ■ Educational Site Visits — Please refer to pages 26–27. By 1 March, US$75 each
■■ Pre- and Postconvention Institutes — Please refer to pages 19–21 for event descriptions.
[PCI1–PCI5] Tuesday, 9 am–4 pm
[PCI15–PCI21] Wednesday, 9 am–4 pm
First Choice
Cardholder name
billing address
State/Province
Zip/postal Code
Country
Signature
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