Registrant Information

First Name      Last Name      M.I.
Home Address      City      State      Zip

Email
Reenter Email


Levels (check all that apply): Primary    Intermediate    Middle    High    College    Other
Are you an NSTA member? Yes No
Are you interested in serving on the KSTA Board of Directors? Yes No

School/Organization Information

School Name      School District      Zip
Organization Name (if applicable)
Address      City      State     

Conference Registration: Thursday through Saturday.
Login Member advance rate $110.00
Member rate on-site $130.00
Non-member rate online $165.00
Non-member rate onsite $175.00
Full-time student $30.00
1st Year Teacher $100.00
Saturday Only Registration
Login Member rate $50.00
Non-member $95.00
Thursday Options PRE-REGISTRATION REQUIRED, NO ON-SITE
6 Hr. Administrator Workshop presented by PIMSER & Univ. of Louisville $0.00
Project Learning Tree 4 Hr. Workshop $0.00
6 Hr. Teacher Workshop presented by PIMSER & Univ. of Louisville $25.00


Payment Options



Credit Card

Name on Card:
Card Number:
Expire Date: /
Card Check Code (CVV):



Check or Money Order

Mail application and payment to:
KSTA
P.O. Box 23918
Lexington, KY 40523-3918



Purchase Order

PO #:

Please print this form and mail with a copy of the PO, or bring copy of PO to conference registration





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   Kentucky Science
   Teachers Association
   P.O. Box 23918
   Lexington, KY 40523-3918
    1-800-381-6280