2018 SRATE Conference Registration Form Innovate, Communicate, Collaborate:Crossing PK-20 Classroom Boundaries Hosted by Florida Association of Teacher Educators (FATE) Florida State University, Panama City Campus -- October 11-13, 2018 Preregistration Due Date: September 10, 2018All presenters must preregister to be included in the conference program. Attendee InformationName* First Last Institution*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone*Email* Name as You Would Like it to Appear on NametagCurrent Position*Is this your first SRATE conference?YesNoConference RegistrationType of Registration*Regular Registration (College/University/District-Level) - $160PreK-12 Teacher - $75Retired Educators - $75Preservice Teachers - $50Prices will go up after September 10Registration includes: Speakers, Sessions, Panels, & Roundtables (Thursday, Friday, & Saturday); President’s Reception (Thursday), Awards Luncheon (Friday), Brunch (Saturday) Please indicate which you will be attending:Reception (Thursday)YesNoAwards Luncheon (Friday)YesNoBrunch (Saturday)YesNoDietary RestrictionRegistrants are invited to bring guests to the conference for an additional fee. Please indicated the number of GUESTS you be brining to each event.Reception Price: $15.00 Quantity: Awards Luncheon Price: $25.00 Quantity: Brunch Price: $25.00 Quantity: Guest TotalExcursion:We will be arranging a Sunset Dolphin Cruise (approximately 1.5 hours) for Friday evening.Sunset Dolphin Cruise Price: $15.00 Quantity: Check OutGrand Total $0.00 How Would You Like to Pay?Credit Card (via PayPal)Check (via mail)Pay by Credit Card using Paypal:After submitting this form you will be directed to Paypal's website to finish your payment. Please keep the confirmation of this email and the confirmation from PayPal as your receipt. Make your check payable to FATE and mail to:Kate Wittrock1175 East Kennedy BlvdUnit 232Tampa, FL 33602 Registration confirmation will be sent via email once fees are received.There is a $25 charge for refunds prior to September 10, 2018; no refunds are available after September 10, 2018.