BPA Region 6 Registration Form

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	Region 6 Leadership Conference
	Sponsored by CSI and the Kimberly High School Chapter
	January 15, 2007

Chapter		Advisor #1
Address		Advisor #2
City		Advisor #3
State	Zip	Contact E-mail
Phone		Fax

No. of Students		@$6 each =
No. of Advisors		@$6 each =
		Total Due

Choose Check if printing completed form and sending check. Choose Bill Me if your district requires an invoice for payment and you would like to be billed upon submission. Please make checks and P.O.s payable to Kimberly High School BPA (see address at bottom of this form):

Check (Total Amount Due)

Purchase Order No. (Total Amount Due)

Comments:

Please use the event number when registering each contestant.

	First Name	Last Name	Event 1	Event 2
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30

Print and mail this form to:

Diane Neale, Advisor
Kimberly High School BPA
885 Center Street West
Kimberly, ID 83341
Phone (208) 423-4170
dneale@kimberly.edu

OR
You may submit your form electronically or by fax if indicating payment by Purchase Order.
NOTE: Print this page before submitting.

This page is sponsored by the
Career and Technical Educators of Idaho.

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