Redefining the Classroom

Registration Form

Registration deadline is 12 noon on Friday, August 19, 2016.
Required fields marked with *.

Tell us about your business, organization or group.

*Organization/Department Name
*Type of Organization or Services provided
*Street Address
*City
*State/Prov.
*Zip/Postal Code


Who should we contact with questions or confirmation materials?

*Contact Person Name
(First and Last)
*Phone Number
(XXX-XXX-XXXX)
*E-mail Address


Who will be representing your business, organization or group?

*1st Participant's Name
(First and Last)
T-Shirt Size S M L XL XXL
2nd Participant's Name
(First and Last)
T-Shirt Size S M L XL XXL
Will there be more than 2 participants?
If yes, how many more?
*Will the participant(s) be joining us for lunch at noon?


To help us plan accordingly, please answer the following questions:

*Do you need electrical power?
(Please note requests for electrical power can not be guaranteed.)

If yes, Please indicate what item(s) will need power and how many items you will have.
Examples: Crockpot (1), laptop (2), tv, etc.
*Do you need internet access?
(Please note requests for internet access can not be guaranteed.)


*Will you have a giveaway or raffle item?


If Yes, please describe:

*Will you have food/beverage items?


If Yes, please describe:

*Do you need additional floor space?


If Yes, please describe:

Questions and Comments:
  

Lakerpalooza