GLPTI - Institute Registration

A * denotes a required field

What type of registration would you like?* Institute Registration

Attendee Personal Information

First Name: *

Last Name: *

Title: *

Park District/Agency: *

Address: *

City: *

State: *

Zip: *

Phone: * () - - ext.

Fax:

Email: *

Is this your first Great Lakes Park Training Institute? * Yes
No

CEU's Information *

You must register for the full institute to be eligible to receive CEU credits.

Yes, I would like CEU's for $10.00
No, I do not want CEU's

Name: *
(As you want printed on your CEU form)

Title:

Park District/Agency:

Address:

City:

State:

Zip:

Birthdate:

Gender:

Institute Registration Fees *

Full Institute - $225.00 before Feb 1^st, $235.00 after Feb 1^st.
Daily Rate - $75.00/day before Feb 1^st, $85 after Feb 1^st.

Check the days for your enrollment: *

Monday
Tuesday
Wednesday
Thursday

GLPTI Registration Payment Option*

By Credit Card
By Check/Money Order
Purchase Order

Purchase Order #: