Annual Conference: November 16-17, 2018
Celebrating the Resilient School Counselor
The Sagamore Resort
Bolton Landing, NY
Name (One Registration form per person)
First Name
*
Last Name
*
E-mail
*
Phone Number-include area code
*
School District Name
Institution Name
*
Address
Street Address (If Work: School or Business Address)
*
Address Line 2
City
*
State/Province
Please Select
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Postal Code
Position Title
*
Work Setting
*
Please Select
Elementary
Middle School
High School
Administrator
Director
Grad Student
Counselor Educator
other
NYSSCA Region (please choose one)
*
Region 1 (Nassau,Suffolk)
Region 2 (Putnam,Rockland,Westchester)
Region 3 (Dutchess,Orange, Sullivan,Ulster)
Region 4 (Albany,Columbia,Fulton,Greene,Montgomery,Rensselaer,Saratoga,Schenectady,Schoharie,Warren,Washington)
Region 5 (Clinton,Essex,Franklin,Hamilton,Herkimer,Jefferson,Lewis,Oneida,St.Lawrence)
Region 6 (Cayuga,Cortland,Madison,Onondaga,Oswego,Tompkins)
Region 7 (Broome,Chemung,Chenango,Delaware,Otsego,Schuyler,Tioga)
Region 8 (Genesee,Livingston,Monroe,Ontario,Orleans,Seneca,Wayne,Yates)
Region 9 (Allegany,Cattaraugus,Chautauqua,Erie,Niagara,Steuben,Wyoming)
Region 10 (Bronx,Kings,New York,Queens,Richmond)
Other (none of the above)
Are you currently a NYSSCA Member? (NYSSCA Membership must be current through December 2018 to qualify for Member Rate) (contact membership@NYSSCA.ORG if you have a question regarding your membership)
*
Please Select
Yes
No
Are you an ASCA Member?
Please Select
Yes
No
Preferred t-shirt size (men's sizes)
*
Small
Medium
Large
X Large
XX Large
XXX Large
Are you a first time conference attendee?
*
Please Select
Yes
No
Please Check One Registration Type. Registration options will then appear. Registration includes breakfast, lunch, coffee breaks & Conference Materials.
Early Bird Registration MUST be submitted by October 16, 2018. If you are uncertain about your membership status, contact Membership@NYSSCA.ORG
Registration Type
*
NYSSCA Member
Non-Member (Includes 1 year NYSSCA Membership)
Graduate Student
Presenter
Volunteer (Approved Only) by Volunteer Coordinator, Joan Cawley. Email Joan at Region6Gov@NYSSCA.Org before registering
NYSSCA Member
*
Early Bird Registration $250 (by Oct 17, 2018)
Regular/Onsite Registration $265
Friday Only $200
Saturday Only $175
Non-member (includes 1 year NYSSCA Membership)
*
Early Bird Registration $300 (by Oct 17, 2018)
Regular/On-site Registration $315
Friday Only $ 250
Saturday Only $225
Graduate Student (includes 1 year membership)
*
Early Bird Registration $180 (by Oct 17, 2018)
Regular/On Site Registration $205
Friday Only $100
Saturday Only $80
Volunteers APPROVED ONLY. Approved by Joan Cawley region6gov@nyssca.org
*
$60
Presenters
*
I will only attend my scheduled Presentation (please remember to Submit your application)
Full Conference $155
Friday Only $90
Saturday Only $65
Form of Payment
*
Check (Please print a copy of this registration form to include with your payment and mail to NYSSCA, Box 217 Leicester, NY 14481)
Purchase Order (Either attach PO to this form below or mail to NYSSCA Treasurer, 25 William Ave, Central Islip, NY 11722) Make sure that your name is on the purchase order.
Credit Card
Presenting Only
Total Due-Check or Purchase Order
*
Purchase Order Attachment-Please attach your purchase order here or mail to NYSSCA Treasurer, 25 William Ave, Central Islip, NY 11722. Make sure your name is on the PO.
Credit Card Registration-Please enter your registration total here.
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NYSSCA 2018 Conference Registration
To provide additional service, we will provide our exhibitors and sponsors with participant emails (only). Check here if you would like to opt out from this service
I would like to opt out
Unless paid by credit card, mail payment to: NYSSCA, P.O. Box 217, Leicester, NY 14481, attention Registration Chair with a copy of your
email receipt
or a printout this form
-Checks and purchase orders must be payable to NYSSCA
-No refunds unless requested prior to 11/9/2018. You may substitute a colleague by 11/14/2018
-Conference & hotel information available at www.nyssca.org
-Make room reservations directly with the
Sagamore,
1-866-384-1944 or click
HERE
. USE Conference Code
NYSSCA1118
for conference room rate by October 16.
-Send conference questions to info@nyssca.org
-Send Registration questions to: Registration Chair, at
registration@nyssca.org
-
Registration for roundtrip bus transportation from Penn Station, Manhattan ($62-credit cards only)
Submit
Print Form
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