Workshop Code___________________ Date:__________________

Name:___________________________________________________

E-mail Address:___________________________________________

Home Address: __________________________________________

City:__________________________State:_______Zip:__________

School Name:____________________________________________

School Address:_________________________________________

City:_________________________State:________Zip:__________

Phone(H):_____________________(W):______________________

         (C):_____________________

Position(s):

[    ] Curriculum Coordinator    [    ] Special Educator

[    ] General Educator            [    ] SLP

[    ] Parent                           [    ] Paraprofessional

[    ] Building Administer          [    ] Other (please specify)

                                           _________________________

Click this link for a printer friendly version: PD Registration

Mail this completed form to:

LTR Tutoring Associates, LLC

#2 Whitney Rd Suite#22

Concord, NH 03301

For more information call LTR at 603-226-7190

Upon receipt of this completed registration form and your payment either by check or school purchase order, your space will be secured and an email confirmation will be sent.

Early registration is strongly recommended as space is limited.

Cancellations made less than 7 days before the event will not be eligible for refund.

Weather may cause rescheduling or cancellation.  In the event of a cancellation a full refund will be awarded.