NERIC REGISTRATION FORM

1.  Send form by FAX (518 456-9287) or mail to: Capital Region BOCES NERIC, 1031 Watervliet-Shaker Rd, Albany NY 12205
      Attn: Janice Hauck
2.  Forms must arrive one week prior to date of session.  Use one form per individual
3.   "No shows" will be billed at the daily workshop rate. No refunds.
4.  A separate memo will confirm registrations.
5.  NERIC Training Certificates (if applicable) are held by building principal.


Name:     District:      Bldg:

Work Address:     Work Phone:      Fax:

Email Address:    Home Address:

Home City, State, Zip:     Home Phone:

 
Name of Session Location  

Fee (incl. Mat)

 Date/Time of Session
 

 

Payment Options-(Check payment option below): FOR BOCES USE ONLY

  []  NERIC Training Certificate # (mail original)

 1. Confirmed _______
  [ ]  Check enclosed (district check preferred) 2. Bill #           _______
  [ ]  "I authorize NERIC to bill the School District named above for this training workshop." 3. Payment    _______
Signed ________________________________________   Title________________________________ 4. Amount     _______

                 (Authorized Signature-Superintendent/Business Manager)