| *Required Field |
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| EVENT* |
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JUNE 25-30, 2012 |
New York, NY |
JULY 2-7, 2012 | Las Vegas, NV |
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| APPLICATION TYPE* |
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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 2012 Teacher Training and Certification Guidelines for details |
| INSTRUCTIONS |
| The Teacher Training and Certification Program application is due by May 18, 2012. 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 and a processing fee of $100.00 will be withheld from total registration and balance applied to the 2013 Teacher Training Program. No Walk-ins accepted once the program has begun. No form substitutions. Absolutely no refunds. |
| 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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| 2012 TUITION* |
LEVEL |
Early Bird Savings
Register on or before
January 31, 2012
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Tuition Fee
After
January 31, 2012
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Member: Level I, II or III
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$900.00 |
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Member: Level III Floater
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$300.00 |
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Non-Member: Teacher Level I, II or III
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$900.00 |
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Non-Member: Teacher Level III Floater
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$350.00 |
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| 2012 DISCOUNTS |
Early Bird Savings: Register on or before January 31, 2012 and pay only $900.00 for Level I, II or III.
25% Savings for Member; 30% Savings for Non-Member. Not valid for Floater. |
| PAYMENT* |
TOTAL COST $
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| 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*:
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