MSCD Urban Teacher Partnership

6th Annual Great Teachers for Our City Schools National Summit:

21st Century Teachers for Urban Student Success

April 3-5, 2013
Embassy Suites Denver Downtown
1420 Stout Street
Denver, CO 80202
(303) 592-1000

GENERAL REGISTRATION FORM

Please complete the entire registration form and submit via the Register button at the bottom of this page. Please refer to step three for payment options.

Step One: Registrant Information

All correspondence concerning the Great Teachers for Our City Schools summit will be sent to the address you provide below. Your name, organization, mailing address, email address, phone and fax numbers will be published in the summit attendee roster.

First Name

Last name

Title

Organization:

Address:

Office Home

City:

State:

ZIP/postal Code

Phone

Fax:

Email:

Step Two: Additional Information

Please indicate your role in your organization:

Step Three: National Summit Registrant Fees

Registration fees include: meals and summit materials. 100% of all registration fees are allocated to the CUE scholarship fund for urban teacher education students.

Three-Day Summit Registration: April 3-5, 2013

Early Bird

Payment received on or before February 28, 2013 $300

Regular Registration

Payment received between March 1 - March 20th, 2013 $350

Late Registration

Payment received between March 21 - March 28, 2013 $350

Daily Rate: April 3-5, 2013

Daily Registration fee $175

The last day to register is: March 28, 2013

There will be no on-site registration.

Please indicate the specific event that you are registering for:

Three-Day Summit

Daily registration(Check One)

Wednesday, April 3, 2013
Thursday, April 4, 2013
Friday, April 5, 2013

Step Four: Payment

Registration Fee:$

If you have an identified Registration Code, enter here:

Payment Method

Credit Card:If paying by credit card, complete the registration form and follow the link on the next page to pay.
For other payment options (check or purchase order), submit this form and contact Carla Mirabelli to make payment arrangements at 303.352.4956

Step Five:Meal Function Registration

Please select the meal functions you will attend

Wed. 4/3 - Opening Plenary and Reception
Thurs. 4/4 - Plenary Breakfast
Thurs. 4/4 - Plenary Lunch
Fri. 4/5 - Plenary Breakfast
Fri. 4/5 - Closing Luncheon

Step Six: Dietary Requirements

Vegetarian
Food allergy
Diabetic
Other:

Step Seven: Liability Waiver and Emergency Contact:

Please read and sign.

I agree and acknowledge that I am participating in the CUE Summit and activities at my own free and intentional act and assume responsibility for my own well-being

Emergency Contact:

Phone:

Hotel Accommodations: Hotel rooms can be reserved by calling the Embassy Suites Denver Downtown at 303-592-1000, please mention the "Great Teachers Summit".

• All persons attending all or any part of the conference must register.
• A registration badge will be required for admission to ALL conference sessions and meal functions.
• No registration will be processed without full payment of the registration fee. Payment in full must accompany the registration form.
• All cancellations must be in writing. No refunds will be made for cancellations made after March 29, 2013.
• If you have any questions regarding your meeting registration and fees, please contact Carla Mirabelli, 303.352.4956

Please contact us or The Embassy Suites if you have any disability needs or to ask questions about the accessibility of hotel accommodations and meeting facilities.