Registration Form for Brain Research Principles and Instructional Strategies

June 20 & 21, 2007
Decatur, IL

Name_____________________________________________________________

Home Address_____________________________________________________

City, State, Zip______________________________________________________

Home County_________________________________     (ex. Cook, Lake, etc.)

Home Phone_______________________________________________________

District________________________ School_____________________________

Position______________________________________ Grades______________

Work Address_____________________________________________________

City, State, Zip_____________________________________________________

Work County______________________________________________________

Work Phone______________________________ FAX____________________

Email __________________________________SS#_______________________

Fees 
IAGC Membership No._______________________
__________$50 New Member fee
__________$190 Early Bird, prior to May 16
__________$230 Late registration, after May 16

IAGC Non-members
__________$240 Early Bird, prior to May 16
__________$270 Late registration, after May 16
No refunds will be made after the first class.  A $25 handling fee will be charged for all cancellations.

One hour graduate of credit is available through Aurora University for an additional  $125, pending
approval.  The registration for graduate credit will take place on the first day of the class. 
CPDU’s available.

To register please fill out the form and mail with your check to:
IAGC Registration,
800 E. Northwest Hwy.,
Palatine, IL 60074

Questions? Call the IAGC office at 1-847/963-1892