"No Standing Around in My Gym" Workshop Registration Form

Please print this form and MAIL or FAX with payment to:

Andy Roloff
Franklin Elementary
1401 W 5th Ave.
Oshkosh, WI 54902

Phone: (920) 424-0078
Fax: (920) 424-7581

Please PRINT.
Fill in ALL information.

________________________________________________________
Participant's Name

________________________________________________________
School

________________________________________________________
School Address

________________________________________________________
City                                                              State                       ZIP

(_______)________________________________________________
School Phone

(_______)________________________________________________
School Fax

________________________________________________________
Email Address

Workshop Registration Fees
**District Purchase Orders Accepted**
Pre-Payment:
$80.00 for teachers
$40.00 for college students IF payment is received TWO days prior to the workshop. Please do not mail cash.

PAYMENT IS TRANSFERABLE but NON-REFUNDABLE.

At the door:
$100.00 for teachers
$50.00 for college students
Must include full payment (check or cash).

Payment Methods Available:
-District Purchase Order
-Check or Cash at the door ($100/$50)
-Check (early registration$80/$40)

*If payment has not been received prior to the workshop, payment will be required at the door.