Event Registration Form

NEW: Click to register and pay with PayPal (Individual Registrations Only)!
Institute Teaching Institute
Location Melbourne Campus
Attendees must make their own overnight accommodations.
Visit the Location page for Motel information.
Dates Oct 17-19

Fee including registration, institute materials, and continental breakfasts and lunches.

$550/person

Multiple-person discount:  Fee applies when teams of three or more from the same institution attend an institute.

 $450/person

If you have any questions, please feel free to contact:

Katina Kodadek at KodadekK@brevardcc.edu
250 Community College Parkway, Palm Bay, FL  32909
321-433-7020 

* denotes a required field

For multiple person or group registration, enter a contact person or group representative in the fields at left and the remaining names, one name per line, below:
* Name:
*  Dept/Discipline:
* Institution:
* Work Phone:
Home Phone:
Fax:
* E-mail:
   
* Select Event:

Teaching Institute

 
   
* Method of Payment:
Please bill me. Use the following Purchase Order number:
A check made payable to "Brevard Community College" is being sent to:

Katina Kodadek
250 Community College Parkway
Palm Bay, FL  32909

I am registering as a participant from the host school. My registration is being paid by my institution.
 
* Payment Amount:
Discount Code (if applicable):

Questions/Comments/Reasons for Attending:

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