2019 SRATE Conference Registration Form Hosted by Florida Association of Teacher Educators (FATE) World Golf Village Renaissance – St. Augustine, Florida November 14-16, 2019 Preregistration Due Date: October 18, 2019All 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) - $175PreK-12 Teacher (One Day) - $50PreK-12 Teacher (Two Day) - $75Graduate Students - $80Retired Educators - $80Preservice Teachers - $50Registration 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: $20.00 Quantity: Awards Luncheon Price: $30.00 Quantity: Brunch Price: $30.00 Quantity: Guest TotalExcursions:We have arranged two different excursions for Friday night.Choose one belowTrolley TourA guided tour on a trolley through St. Augustine$14/adult (12 and older) | $6.50/child (age 5-11)Ghost TourAn interactive ghost tour through historic St. Augustine$20/adult (12 and older) | $10/child (age 5-11)No excursions Trolley Tour of St. AugustineAdults (12 and older) Price: $14.00 Quantity: Children (age 5-11) Price: $6.50 Quantity: Ghost TourAdults (12 and older) Price: $20.00 Quantity: Children (age 5-11) Price: $10.00 Quantity: Excursion SubtotalJoin FATE:You can join FATE for the 2019-2020 season for $30FATE Membership (2019-2020) - $30Renew My MembershipNew FATE MemberNot TodayCheck 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 October 10, 2019; no refunds are available after October 10, 2019.
