Registration Form

URGENCY AND SCHOOL CHANGE CONFERENCE

March 9-11, 2011 ▪ Seattle, WA
www.urgencyandschoolchange.com

Keynotes and sessions with Andy Hargreaves, Richard Allington, Kathryn Au, Taffy
Raphael, Regie Routman, and Routman colleagues

Complete the following information and fax to (206) 296-2691 or send with payment to:

Seattle University
College of Education
Prof. Dev/Cont. Ed.,
Attn: M. Klein
901 12th Ave
PO Box 222000
Seattle, WA 98122-1090

Questions about registration: Call (206) 296-2147 or email ContinuingEd@seattleu.edu.

Please register me for:

Title: Date and Fees:

location:
Individuals: $495.00
Team of three or more: $450.00/person
Urgency and School Change March 9-11, 2011
Conference Seattle, WA Fee includes a full breakfast and afternoon snack each
day. Hotel, transportation, and other meals are not
included in the conference registration fee.

For team registration, each participant must be listed on the registration form.

Name 1:
Address:
#/STREET CITY STATE ZIP
Phone # ( ) Position:
DAY
District:
CITY STATE ZIP
E-mail:

Name 2:
Address:
#/STREET CITY STATE ZIP
Phone # ( ) Position:
DAY
District:
CITY STATE ZIP
E-mail:
Name 3:
Address:
#/STREET CITY STATE ZIP
Phone # ( ) Position:
DAY
District:
CITY STATE ZIP
E-mail:

Name 4:
Address:
#/STREET CITY STATE ZIP
Phone # ( ) Position:
DAY
District:
CITY STATE ZIP
E-mail:

Name 5:
Address:
#/STREET CITY STATE ZIP
Phone # ( ) Position:
DAY
District:
CITY STATE ZIP
E-mail:

Total Amount: $
Please note: Payment in full is required to hold registration for individuals or teams

Method of Payment (check one):

 Check (make payable to Seattle University)

 Purchase Order #

 Visa  MasterCard /
CREDIT CARD NUMBER EXPIRATION DATE

Signature X Date:

• The conference is limited to 200 participants. Register early with your school team. The first 10 school teams
to register will be invited to send one team member to an intimate conversational luncheon with Andy
Hargreaves on March 9.

• Registration deadline: February 23, 2011

• Credits and clock hours: Two graduate credits are available through Seattle University for an additional fee of
$40, payable on site. To receive continuing education-level credit, attendance at one of the March 10 optional
sessions is required. Washington participants may choose to earn clock hours, also payable on site.
• Registration cancellation: Seattle University has a no-refund policy. Should you be unable to attend, you may
send someone in your place.
• Program cancellation: We reserve the right to cancel programs because of low registration or other
events/circumstances beyond our control.

For more information about Seattle University professional development opportunities, visit us at www.seattleu.edu/coe.