La Cosecha Individual Registration November 19 - 22, 2014 Santa Fe, New Mexico Registration Deadline is Sept. 30, 2014. Postmark deadlines will be strictly adhered to and payment is required to guarantee registration. Choose Your Registration How to Register Online: www.dlenm.org/lacosecha2014 Mail: Fax: La Cosecha Registration Type La Cosecha 2014 1309 4th Street SW, Suite E Albuquerque, NM 87102 (505) 243-0377 Registration questions: Phone: (505) 243-0648 Email: Leslie Sánchez – leslie@dlenm.org Total FUENTE365 Rate* $375 $ New FUENTE365 Rate $425 $ Non FUENTE365 Rate $475 $ Lead Presenter $185 $235 $ Co-Presenter $475 $525 $ Student/Parent $185 $235 $ Last Name _______________________________________________ School/Organization Please check one Please check  the appropriate registration box. ADD _______________________________________________ Deadline Nov. 14, 2014 FUENTE365 Individual Registration First Name Late Registration Teacher - Grade Level ____ Administrator Parent Student _______________________________________________ Email Address* _______________________________________________ Mailing Address Thurs. One Day Registration ______________________________________________________ Work Phone Cell Phone $295 $ Must register for the conference by Sept. 30. Space is limited to the first 200 registrants. Optional Events $75 School Visits -Wed. Nov 19th $ New Program Pre-Conference Inst. *Current DLeNM Clearinghouse subscribers qualify to receive the FUENTE365 discounted registration rate. Please Circle One Check (Make payable to DLeNM or La Cosecha) • Registration substitutions will only be accepted upon receipt of a written request on letterhead faxed to 505-243-0377, and received by October 31, 2014. The request must include the name of the original registrant and the name and contact information for the new registrant. • Cancellation and refund requests must be made in writing, postmarked on or before October 15, 2014. A processing fee of $100 will be assessed per registration cancellation, and will be issued six weeks after the conference. No refund requests postmarked after October 15th will be honored. There will be no refunds or exchanges for school visits. Method of Payment *To ensure you receive full FUENTE365 benefits you must utilize your district email address for registration. • Registration will be processed ONLY when accompanied by complete credit card information, check or copy of purchase order. If paying with a purchase order or institutional check please include participant’s name. All registrations must be paid in full before the participant arrives at the conference. There will be no on-site registration. Registration closes November 14, 2014. $ Total Registration Fees $ ______________________________________________________ Fax Policy & Payment Procedure N/A Spanish Academy $125 Wed. Nov. 19th ______________________________________________________ CityStateZip Fri. Visa MasterCard American Express PO#____________ Discover _____________________________________________ Credit Card No. Exp. Date _____________________________________________ Name on Credit Card _______________________________________________________ Signature _______________________________________________________ Billing Address for Credit Card _______________________________________________________ CityStateZip _______________________________________________________ District/School _______________________________________________________ Telephone Registration form and payment information must be received via fax or email by September 30, 2014 to secure the early registration rate. Questions regarding registration, payment, or policies and procedures? Call (505) 243-0648 or visit us online at www.dlenm.org/lacosecha2014.