Extraclassroom Funds Registration Form

Student Extraclassroom Activity Funds Workshop
Registration Form - Summer 2006

Program or Workshop Location:
Name of School District:
Address:
City:
State:		Zip:	Other State:
Phone Number:		( ) -
Fax Number:		( ) -
Contact Email:
Number of Attendees: Name: Title:
Program or Workgroup costs: Cost - The cost of the workshop is $175 for one person, $150 for the second participant, and $125 for the third and subsequent participants from the same school district. This program or Workshop is BOCES aidable through COSERs 504 and 512 - cross-contract with the Greater Southern Tier BOCES.
Total Amount $
	Check or purchase order number:
	Please bill through my BOCES on cross-contract with the Greater Southern Tier BOCES, COSERs 504 and 512 as Follows
Name of BOCES Note: School districts who are not components of the Greater Southern Tier BOCES must request a cross-contract for coordination COSERs 504 and 512 Superintendent's Name Questions: State Office (716) 672-5473