Register for the 2018 Arizona Out-of-School Time Conference! Questions about registrations? email firstname.lastname@example.org 2018 Conference Registration Step 1 of 3 33% Primary Program Contact:* First Last This person is the primary point of contact should AzCASE have questions relating to your registrations.Job Title*Organization/Program*i.e. "Boys and Girls Club of Metro Phoenix", "Flagstaff USD - FACTS Program", "Pima County Library", "City of Phoenix - PAC Program"Site*The physical location of your program, i.e. "Jerry Colangelo Branch", "Kinsey Elementary School", "Flowing Wells Branch Library", "ASU Preparatory Academy" Enter "N/A" if site designations are not applicable to your organization, or "VARIOUS" if you oversee multiple sites.Primary Contact Email:* Primary Contact Phone:*Mailing Address for Organization/Program:* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code County*MaricopaPimaApacheCochiseCoconinoGilaGrahamGreenleeLa PazMohaveNavajoPinalSanta CruzYavapaiYumaIs your Program a 21st Century Community Learning Center?Yes Conference Pricing Early Bird Rate: $95/each (available through August 15th) 1-9 Attendees, $110/each (after August 15th) 10+ Attendees, $95/eachHow many attendees are you registering today?*Please enter a value between 1 and 40.AttendeesTotal $0.00 Do any of your attendees require a vegetarian lunch option?*NoYesPlease indicate how many vegetarian lunches for your group:Please enter a value between 0 and 20.AttendeesFirst NameLast NameEmailOrganization/ProgramSiteJob Title Organization/Program: i.e. "Boys and Girls Club of Metro Phoenix", "Flagstaff USD - FACTS", "Pima County Library", "City of Phoenix - PAC Program" Site: The physical location of the program, i.e. "Jerry Colangelo Branch", "Kinsey Elementary School", "Flowing Wells Branch Library", "ASU Preparatory Academy" Enter "N/A" if site designations are not applicable to the organization, or "VARIOUS" if the attendee oversees multiple sites. I would like to pay via:*Credit Card (PayPal)CheckPurchase OrderValley of the Sun United Way Partner Youth Program Checks should be made out to "Arizona Center for Afterschool Excellence". Checks and purchase orders can be mailed to 77 E. Weldon Ave. Suite 210, Phoenix, AZ 85012. Purchase orders can also be e-mailed to email@example.com. Refund and Cancellation Policy: Cancellations must be sent in writing to firstname.lastname@example.org by Monday, October 1st, 2018 to be eligible for a refund. All cancellations after that date, including no-shows, are non-refundable. After October 1st, individuals or organizations with confirmed registrations or reservations are liable for all related registration fees, including payments that have not yet been received by AzCASE at the time of cancellation. We are unable to make exceptions for emergencies; However, you may send a substitute in the place of a registered attendee. Please note that cancellation checks will be issued after the Conference.* Agree Photo Release Acknowledgement: I understand that photographs may be taken during the above-named registrants’ participation in any activity (workshop, conference, meeting, etc.) with the Arizona Center for Afterschool Excellence (AzCASE) or at an event sanctioned by AzCASE. I am authorized to hereby grant permission to AzCASE to use photographs of these registrants in any publicity or promotional publications (e.g. website, social media, newsletters, programs, brochures, etc.). To opt out of photo release, please call 602-734-5434 x102.* Agree NameThis field is for validation purposes and should be left unchanged.