*One six hour EILA credit approved session is available annually to KASA active members at no cost as part of members' benefits and services. If you have not already used this benefit for 2010-11, you may register at no charge.

First Name:

Middle Initial:

Last Name:

Prefix/Title:

Dr. Mr. Ms.

Position:

District:

School:

Address:

City:

Zip Code:

A/C Phone:

Mobile Phone:

Fax Number:

E-mail:

*Required

Please register me for the following.

Webinar (full)

Face-to-Face at the KASA Office (total of 15 seats available)

On-Demand (you will receive an email once this is available)

Member Type:

KASA active member Free*
Retired, Associate, or Student Member $69
Nonmember $119

Payment Options

Purchase Order #

Check (Note: I've printed this form and mailed it with my check to 152 Consumer Lane, Frankfort, KY 40601)

I am an active member attending free.

All sessions have been approved for 2 hours EILA credit.
Cancellation Policy: Written cancellation will be accepted until 48 hours prior to the date of the session.
KASA reserves the right to cancel any workshop that does not have adequate participation.

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Wayne Young, Executive Director, General Counsel
Rhonda Caldwell, Deputy Director
Clyde Caudill, Legislative Liaison
Wanda Darland, Web, Publications, & Affiliate Services Coordinator
Shirley LaFavers, Director of Professional Development

152 Consumer Lane
Frankfort, KY 40601
(800) 928-KASA or
(502) 875-3411

Fax (502) 875-4634