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2019 Nebraska Afterschool Conference
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School/Agency Information
School/Organization Name
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School/Organization Mailing Address (Street/PO Box)
Your answer
School/Organization Mailing Address (City/State/Zip)
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Who should receive this bill?
School/Agency Information
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Name of Person
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Email of Person Receiving the Bill
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Personal Information
I am registering as:
Attendee - $60 registration fee per person if paid by October 11, 2019
Presenter - $30 registration fee per person if paid by October 11, 2019 (limit of two per session)
Presenter - FREE registration if not staying for lunch
"Walk 'N Talk" Display Table - FREE registration fee for one
Other:
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First Name
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Last Name
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Current Position
Administrator
Business Partner
Community Partner
Program Leader/Site Coordinator
Program Staff
School-Day Educator
Other:
Email
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Phone # (not required)
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Diet/Accommodations
None
Gluten Free
Vegan
Vegetarian
Dairy Free
Other:
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We would like to know the following:
What 3 topics would you be interested in networking about during this conference?
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