Name:  Last ____________________First ________________________

Address_______________________________________________

Home phone_____________________  Work phone ___________________

Email:__________________________   School: ______________________

District/Agency name: _____________    Occupation title: ________________

*Registration must be mailed by October 31, 2005.  Late registrations will be processed on a space available basis. No Refunds After October 31, 2005  

Check your conference choice(s):

 
____ Pre-conference.................................................................................$100.00
        Sunday, November 13, 2005       1:00 p.m. to 5 p.m.
        ____ Dr. Linda Dorn, Reading Recovery Trainer (Classroom teachers)
        ____ Mary Lose, Reading Recovery Trainer (Reading Recovery teachers)
 
____ Conference......................................................................................$150.00
        Monday, November 14        Tuesday, November 15, 2005
 
____ One day only...................................................................................$100.00
        ___ Monday, November 14, 2005        ___ Tuesday, November 15, 2005
 
Registration Total                                                                               $ _______
 

Mail individual complete registration forms(s) with check or purchase order payable to MARRE :

Ann Munoz, Treasurer 512 Austin Street Ste. Genevieve, MO  63670

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