| *Required Field |
|
Downloadable 2011 TT Application |
| EVENT* |
|
JUNE 19-24, 2011|
New York, NY |
JUNE 29 - JULY 4, 2011| Las Vegas, NV |
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| APPLICATION TYPE* |
|
Level I
Level II *
Level III **
Level III Floater *** |
| ELIGIBILITY |
| All applicants must be 18 years of age or older and have at least 4 years of teaching experience at time of registration |
* Individuals who have passed Level I, with qualifying scores, are eligible for Level II.
** Individuals who have passed Level II, with qualifying scores, are eligible for Level III.
*** Registrants must have completed Levels I, II and III. See TT Guidelines for details |
| INSTRUCTIONS |
All Teacher Training Applications Are Due By APRIL 15, 2011. Submit completed application. Keep a copy of application for your records. All registrations will be confirmed once all documents and full payment is received. Participants unable to attend due to injuries or serious illness after registration must send by fax or mail, a signed Doctor’s certificate stating medical reason for cancellation. A processing fee of $100.00 will be withheld from total registration and balance applied to 2012 Teacher Training Program. NO Walk-ins accepted once the program has begun. No form substitutions. ABSOLUTELY NO REFUNDS.
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| APPLICANT INFORMATION* |
| Check ONE:
DEA Member
Non-Member |
| First Name:
Last Name:
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| Date of Birth:
Home Phone:
Cell Phone:
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| Mailing Address:
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| City:
State:
Zip code:
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E-Mail:
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| 2011 TUITION* |
LEVEL |
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Member: Level I, II or III
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Member: Level III Floater
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Non-Member: Teacher Level I, II or III
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Non-Member: Teacher Level III Floater
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| 2011 DISCOUNTS |
| Early Bird Discount: Register on or before January 1, 2011 |
$ (100.00) |
|
| PAYMENT |
TOTAL COST $
|
| APPLICANT'S SIGNATURE |
| I, the Applicant, agree that the information provided is accurate and true and acknowledge I have read the terms and conditions of this registration application including the no refund policy. DEA is not responsible for personal injury or loss of personal belongings at the event. |
| Applicant's Initials*:
|