TURKEY RUN WORKSHOP REGISTRATION:
Please complete this form and complete BOTH pages. Submit the form and send your check made payable to: IICCA

To download this form in pdf format, click here

Name: Title:

School: Phone:

School Address:

City: State: Zip:

Home Address:

City: State: Zip:

Phone:

Email 

Affiliation:  ICT  COE ICE ME    FACS AG ___ OTHER

REGISTRATION & DUES:

	2010 IICCA WORKSHOP REGISTRATION (includes a new thumb drive to copy materials, etc.)	$30
	IICCA 2009-10 DUES (Indiana Industrial Cooperative Coordinators Association)	$10
	Indiana ACTE DUES (Indiana Association of Career and Technical Education)	$30
	ACTE DUES (National Association of Career and Technical Education)	$60
	OTHER AFFIALATES DUES
	TOTAL