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2012 south dakota early childhood education conference thursday ­ saturday april 12 ­ april 14 2012 holiday inn hotel and convention center 305 north 27th street website http sdececonference-org.doodlekit.com spearfish sd 1 please print or type your name as you wish it to appear on your name badge complete a separate form for each registrant name organization mailing address city phone email all correspondence will be sent via email state fax zip 2 please check all boxes that apply what is your age 18 24 25-30 31 36 37-45 46 65 what is your ethnic background asian african american caucasian hispanic native american other specify what age group do you work with please check all that apply infants toddlers preschool primary adults other what type of setting do you work in please check all that apply administration child care center elementary school family child care head start higher education nutrition services preschool other specify membership status please check all that apply aeyc member head start early head start full time student non member presenter one person per registration form one presenter discount offered per session membership id program name program name student id college/university name affiliate/chapter name planting the seeds of change april 12 14 2012 page 1

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early bird registration fees will be accepted through march 1 2012 any registration forms turned in after this date will be charged regular fees listed below request for refunds will not be honored after march 18 2012 a $20 processing fee will be deducted from all refunds no refunds will be given for meals returned checks will be assessed a $30 fee registration forms must be postmarked by april 4 2012 after this date on-site registration will apply 3 registration information pre-conference thursday tickets will be required for admission cathy cole personal and professional leadership 8:30 11:30 a.m judy harris helm the power of projects 8:30 11:30 a.m $50 $50 presenter one per session full conference registration thursday-saturday early bird postmarked by march 1 2012 member nonmember student $80 $100 $25 early bird postmarked by march 1 2012 $45 $65 $25 regular postmarked after march 1 2012 $95 $115 $50 regular postmarked after march 1 2012 $65 $85 $45 on-site $115 $135 $80 $40 $50 $25 presenter one per session one day registration please choose day you will be attending thursday friday saturday member nonmember student on-site $65 $85 $50 $20 $25 $25 presenters not planning to attend any other portion of the conference please mark here friday april 13 sdhsa recognition luncheon saturday april 14 sdaeyc business meeting luncheon please list special meal requests luncheons sdhsa buffet smoked pork loin roasted turkey potatoes steamed veggies and salad taste of tuscany lasagna pasta red/alfredo sauce caesar salad and garlic breadsticks $15 $15 t-shirt orders please submit any t-shirt orders by march 1 t-shirts will be white with the conference logo placed in color on the front left chest shirt style short sleeve long sleeve small $10 $15 med $10 $15 large $10 $15 xl $10 $15 xxl $12 $17 xxxl $15 $18 total pre-conference total conference fee total luncheon fee t-shirt fee donation to conference if you are under the americans with disabilities act and you require auxiliary aids or services please attach a description of your needs with this form and return it no later than april 4 2012 mail registration form and payment to 2012 sdece conference po box 1031 pierre sd 57501 receipt required total payment thank you please visit http sdececonferece-org.doodlekit.com for more information planting the seeds of change april 12 14 2012 page 2

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