Arizona Center for Afterschool Excellence

Select Registration Type

Option A - Conference Registration

Includes keynote address, three breakout sessions, lunch, door prizes, and exhibits.

Single registration, $85 per participant

Option B - Group Conference Registration for Group of 10 or more

Includes keynote address, three breakout sessions, lunch, door prizes, and exhibits.

Group registration, $80 per participant

REFUND POLICY: Conference registration cancellations received prior to Friday, October 21 will receive a 100% refund. Registration cancellations received after Friday, October 21 will NOT be refunded.

SCHOLARSHIPS are available for registration or travel expenses. For information about scholarships, contact Caitlin King at caking@azafterschool.org or 602.496.3308.

Please Complete the Following for Each Registrant

First Name	Last Name
Agency	Address
City	State
Zip Code	Phone	Enter the value in format 123-123-1234
Fax	Total number of children and youth in the program
E-mail

Position/Title

School-Age Program Type

Please be sure to add all Registrants before clicking Submit button

Payment Method

Will mail check

Purchase Order #

Credit Card