Teacher leader institutes

TEACHER LEADER INSTITUTES

BANGKOK OCTOBER 2017 INSTITUTE REGISTRATION

Mail to: PTC, 1666 Kennedy Causeway Suite 207, North Bay Village, FL 33141, USA Call: [phone]

Fax to: [phone] (use fax if including credit card information)


Permanent email (will not change)_____________________________________

Secondary email_________________________________________________

Emergency contact & phone number _________________________________

School Administrator name and email (for invoices)

_______________________________________________________________

Nationality_____________________________Gender___________________

How did you learn about the TLI institutes?

 Email from PTC  Friend/colleague Online  From my School

Is your school funding your course?  Yes  No Partially

 Are you graduating with a TLI certificate?  Yes  No

I will bring a:  PC  Mac Chromebook  iPad/Tablet (not recommended)

First Name _____________________________________________________

Last Name _____________________________________________________

Full Name (for Certificate) __________________________________________

Nickname (for nametag if different) ____________________________________

School ________________________________________________________

School Country _______________ Division  K-12  Early  Primary  Sec.

Position _______________________________________________________

Choose: Head, Principal, Curr. Dir., Dep’t Head, Grade Lvl Ldr, Teacher. Specify other

Personal Phone (incl. country code) _______________________________________


PERSONAL INFORMATION (please fill in completely)

• 
  Digital Tools for International School Leaders
  

OR

• 
  Curriculum Design for International School Leaders
  

6-7 Oct 2017 Banyan Tree Hotel Bangkok

 Course only $___________

TOTAL DUE: $___________

Non Member Fee: No Accommodation $595

PTC Member Fee: No Accommodation $535

Fees Per Course

Full payment due at time of registration. Cancellation policy: Before 1 September 2016 $200 of total cost per course is NONREFUNDABLE. After 1 September Entire fee (per course) is NON-REFUNDABLE. Any remainder will be retained as a credit.

Accommodation is not included in the course fees. For a list of hotels near the event hotel, visit http://www.theptc.org/tli-bangkok-fall-2016.

PAYMENT

 US$ DOLLAR CHECK (Drawn on US bank only - payable to PTC) ENCLOSED, CHECK #_______________________ AMOUNT _________________________

 WIRE TRANSFER: Email [e-mail] or call [phone] for details.

VISA MASTERCARD AMEX DISCOVER CARD#________________________________________ Exp. Date ____________ Security Code __________

Name on card ________________________________________ Billing address ___________________________________________________________________

Billing phone________________________________________ ___________________________________________________________________

Authorized amount to charge $_____________ Cardholder authorized signature______________________________________ (All credit cards are processed in US Dollars)

Email to: [e-mail] or Register Online: www.ThePTC.org