ASU CHILDHOOD SERVICES 2009 Early Childhood Education Conference Registration form

Jonesboro, AR ◊ August 10-12

39th Annual Early Chilhdood Education Conference ◊ August 10-12, 2009 ◊ ENGAGE, CHALLENGE, INSPIRE, LEAD ◊ www.asuececonference.blogspot.com
Last name First name TAPP Registry ID # (or SSN)

Summer Mailing Address City State ZIP

Organization /Workplace Work Address Your Preferred Phone #

□ Check here if you plan to

E-mail (Important! Your registration confirmation will be e-mailed to you if possible.) attend the Curriculum Institute

Annual Conference Registration—Monday through Wednesday (Aug. 10-12)

1. Early Bird Registration 2. Regular Registration 3. One-Day Registration Only
Fees (If Postmarked by June 15): Fees (Through July 20): Fees:
Registration □ $99 Registration □ $125 Registration □ $55
Box Lunch □ $24 Box Lunch □ $24 Monday or Tuesday (circle one)

Dinner (Mon. only) □ $12 Dinner (Mon. only) □ $12 Box Lunch □ $8
Undergraduate Credit (1 hr.) Undergraduate Credit (1 hr.) 4. Curriculum Institute
Resident □ $163 Resident □ $163 Fees:
Non-Resident □ $427 Non-Resident □ $427 Registration □$175
Graduate Credit (1 hr.) Graduate Credit (1 hr.) (includes lunch all 3 days)

Resident □ $208 Resident □ $208 Dinner (Mon. only) □$12

Non-Resident □ $530Non-Resident □ $530
Purchase Orders, Money Orders, and Checks Accepted   —> —> —>   TOTAL Registration fee enclosed   $_________
(payable to ASU Childhood Services) 
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*Undergraduate or Graduate Credit Options are contingent upon prior ASU or ASU Graduate School Admission. 
**Lodging & breakfast will not be available on campus this year. Childhood Services has negotiated a conference rate with these area hotels: 
  Comfort Suites, 3404 Access Road, 870.336‐2280, $93/night , free continental breakfast, indoor pool, free wi‐fi, all rooms suites  
  Holiday Inn Express, 2407 Phillips Drive, 870.932.5554, $85/night, free continental breakfast, fitness center, free wi‐fi, business center 

Scholarship Information
ASU Childhood Services and DHS Division of Child Care and Early Childhood Education are pleased to announce a limited number of 
scholarships for the conference. Employees of licensed and registered child care programs are eligible to apply. The purpose of the 
scholarship is to improve the quality of early childhood programs in the state of Arkansas through staff development opportunities. 
Scholarships are available for centers and family child care homes.  
 

If awarded, your scholarship will cover the cost of 3‐day registration only. The scholarship will not cover the cost of meals, lodging, 
travel expenses, college credit courses, continuing education units (CEUs), or substitute staff costs.  
 

Scholarships are available on a first‐come, first‐
served basis,   Check here if applying for scholarship □
using the following criteria:  Number of years your program has been in operation
 Staff employed for less than a year in a child care 
facility  Licensed capacity of program License #
 Programs on program improvement plans  Your position within program
 New child care facilities  Number of years you have been employed in child care
 Licensed capacity of program  Have you attended this conference before?

Return form to ASU Childhood Services, Attn: ECE Conference 
PO Box 808 
State University, AR 72467 
(No faxed forms accepted)