Registration Form
Nineteenth Annual Hawai'i National Great Teachers Seminar

Please print out this form and fill in your information. Send to the seminar director by regular mail.

Registration fee is $950 per participant, based on double occupancy.
Fee includes 5 nights accomodations and all meals. A limited number of single rooms are available for an additional $200.

Mail to:
Hawai'i National Great Teachers Seminar; 96-045 Ala Ike; Pearl City, HI 96782
Contact Info: 808.455.0483 cindymar@hawaii.edu

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Name of Participant:	____________________________________________________
Sex*:	____________________________________________________
Name for Name Badge:	____________________________________________________
Teaching Field(s):	____________________________________________________
Name of College:	____________________________________________________
College Address: Street No./Bldg.:	____________________________________________________
City/State/Zip:	____________________________________________________
Home Address: Street No./Bldg.:	____________________________________________________
City/State/Zip:	____________________________________________________
College Telephone No.:	____________________________________________________
HomeTelephone No.:	____________________________________________________
FAX Telephone No.:	____________________________________________________
Email Address:	____________________________________________________
Total Years of Experience in Education:	____________________________________________________
Single Room request: (additional $200)	____________________________________________________