Arizona School Administrators
Qualified Evaluator Workshop
1910 W. Washington St.
Phoenix, Az 85009
FAX: 602-252-8862

TO REGISTER
(Fill out and print this form then mail to address above
be sure to include check or PO)
THIS FORM MUST BE ACCOMPANIED BY A CHECK OR P.O.

NAME
POSITION
DISTRICT
SCHOOL
ADDRESS
CITY ZIP   
PHONE    EMAIL  
Confirmations will be e-mailed

REGISTRATION FEES FOR EACH DAY
Phoenix Area Workshops ASA Member: $115   Non-Member: $165
Flagstaff/Tucson Area Workshops  ASA Member: $125Non-Member: $175
NO REFUNDS or RESCHEDULING

WORKSHOP CHOICE
Due to limited space in the workshops, registration will be made on a space-available basis upon receipt of completed registration form with P.O./check. NO WALK-INS ACCEPTED.
Each level is a separate workshop. FEES MUST BE PAID FOR EACH LEVEL

LEVEL I   LEVEL II
____July 24  ____July 25
____August 18  ____August 19
____August  21  ____August 22
____August  25 (Tucson)  ____August 26 (Tucson)
____August  28  ____August 29
____September 11 (Flagstaff)  ____September 12 (Flagstaff)
____September 22  ____September 23
____September 25  ____September 26
____October 23  ____October 24
____November 6  ____November 7
____December 4  ____December 5
____January 15  ____January 16
____February 5  ____February 6
 
LEVEL III		   
LEVEL IV
____October 20  ____October 21
____December 11  ____December 12
____February  19  ____February 20
____March 12  ____March 13

     

ASA OFFICE USE ONLY
CHECK #TOTAL
PO #INVOICE #
R-4063DEPOSIT#