Multicultural
Summer Institute, XII
“Fibers of America
FOR REGISTRANTS OUTSIDE OF
PRINCE WILLIAM COUNTY PUBLIC
SCHOOLS ONLY
PRE-REGISTRATION
FORM
Please TYPE or
PRINT clearly all responses on this form.
This form may
be reproduced.
Name
___________________________________________________________________________
Position/Title
____________________________________________________________________
School/Department
_______________________________________________________________
School Division/Organization
______________________________________________________
Mailing Address
___________________________________________________________________
City, State, Zip
____________________________________________________________________
Home Phone #
_________________________ Work
Phone # _________________________
Fax #
__________________________________ E-Mail
Address _________________________
A registration fee of $40.00
per day or $100.00 for all three days is required for educators from other
school divisions. Requests for refunds
will not be honored. You may send
payment or check, money order, or purchase order payable to PRINCE WILLIAM
COUNTY PUBLIC SCHOOLS, along with a copy of this completed registration form
to:
Mr. Melvin J. Brown
Supervisor, Office of
Multicultural Education
Prince William County Public
Schools
