2021 Annual Conference Registration Form University of Tampa – Tampa, FloridaLearn more about the conference here Join Us on December 4, 2021 All presenters and co-presenters must register by November 13th 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 Florida County*Choose a CountyAlachuaBakerBayBradfordBrevardBrowardCalhounCharlotteCitrusClayCollierColumbiaDeSotoDixieDuvalEscambiaFlaglerFranklinGadsdenGilchristGladesGulfHamiltonHardeeHendryHernandoHighlandsHillsboroughHolmesIndian RiverJacksonJeffersonLafayetteLakeLeeLeonLevyLibertyMadisonManateeMarionMartinMiami-DadeMonroeNassauOkaloosaOkeechobeeOrangeOsceolaPalm BeachPascoPinellasPolkPutnamSanta RosaSarasotaSeminoleSt. JohnsSt. LucieSumterSuwanneeTaylorUnionVolusiaWakullaWaltonWashingtonPhone*Email* Name as You Would Like it to Appear on Nametag* Current Position* Is this your first FATE conference? Yes No Conference RegistrationType of Registration*Professional - $125PreK-12 Teacher - $90Students - $30Retired Educators - $65Already Registered - Adding Options ($0)Registration includes access to all program sessions and awards luncheon. Conference registration includes FATE membership for the 2021-2022 academic year and one t-shirt.Size of Free ShirtSmallMediumLargeExtra LargeXX LargeAdditional Shirts are $15 Each I would like to buy one additional shirt Add additional FATE T-Shirts Price: $15.00 Quantity: Size for Additional Shirts Breakfast (Optional)Due to COVID-19, an optional boxed breakfast will be available for your convenience at the purchase price of $10.No BreakfastEnergy Box: Breakfast sandwich (egg, cheese, and bacon on an English Muffin) and a Granola Bar (sweet and salty almond)Protein Box: Low-fat strawberry yogurt, cheese, and grapesPastry Box: Bagel with cream cheese and fruit cupLunch will be provided for all registered conference guests A buffet will be served to include Chicken Marsala, mashed potatoes, mixed green vegetables, salad, brownies, and soda/water.Note:Lunch is gluten-free, with vegetarian options present.Coffee and water will be available to you throughout the full day.Freshly baked cookies will be served in the Grand Salon during the poster presentation session and reception.Dietary RestrictionsWe will try to accommodate any dietary needs. Contact us for more information. Mindfulness WorkshopWhat: Start your day by engaging in meditation and mindfulness, as well as gain insight into strategies to lead your teacher candidates and graduate students to intentionally care for their mental wellness.Who: The workshop will be hosted by Frameworks of Tampa Bay, a leader in SEL across our state.Where: University of Tampa’s Plant HallWhen: Saturday, December 4, 8-9am Price: $10.00 Quantity: FATE Evening ExcursionJoin us for a sea-side tour of beautiful Tampa BayWhat: Catered dinner, 2 drinks, cruise, and live holiday musicWhen: Friday, Dec. 3, 5:30-9:30Where: Yacht Starship Price: $99.00 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 November 13, 2021; no refunds are available after November 13, 2021.CommentsThis field is for validation purposes and should be left unchanged.