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Health Science Day-Registration

Registration Information (Please submit a separate form for each registrant)

 

First Name:             

Last Name:              

District/Agency:      

Mailing Address:     

City:                          

State:                        

Zip:                           

Phone:                     

Email:                      

 

Payment Info:   Direct Bill             District PO            Credit Card

 

Registrants paying by Credit Card will need to call 785-825-9185 to submit payment information.  SHESC does NOT accept Discover.

District P.O. Number:

Special Requests (diet considerations, physical accommodations, etc):   

 

Please make checks/purchase orders payable to: 

Kansas Association of Education Service Agencies (KAESA)
605 East Crawford
Salina, KS 67401
Phone:  785-825-9185   Fax:  785-825-9195
KAESA Tax ID #48-1189820

 

Registration Cost and Cancellation Policy:

Early registration deadline is October 15, 2018...$50

Registrations received after October 15 will be $100.

Cancellations will be refunded in full if written notice of cancellation is provided by October 12, 2018.

 

         

 

 

 

 

 

 

 

 

 

 

 
 

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