Register for the CSRP 3-Day Workshop: June 2019 Use this form to register up to 5 attendees by credit card or PO. For the Grand Prairie event, payment by check or credit card is due by 5/21/19. For the San Antonio event, payment by check or credit card is due by 6/12/19. Contact InformationPerson preparing registrationContact Name* First Last Contact Email* Contact Phone #*Billing InformationSchool District or Company*Campus or Department*Billing Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Pricing and OptionsNumber of Registrants*Please enter a number from 1 to 5.CSRP 3 Day Workshop*$850 per registrant Lone Star Park, Grand Prairie, June 4, 5, & 6, 2019 Menger Hotel, San Antonio, June 27, 28, & 29 Choose your date and location below. Grand Prairie in JuneSan Antonio in JuneRegistrant InformationRegistrant Name* First Last Registrant Email* Registrant Title/Role*Second Registrant Name* First Last Second Registrant Email* Second Registrant Title/Role*Third Registrant Name* First Last Third Registrant Email* Third Registrant Title/Role*Fourth Registrant Name* First Last Fourth Registrant Email* Fourth Registrant Title/Role*Fifth Registrant Name* First Last Fifth Registrant Email* Fifth Registrant Title/Role*Registration Summary & PaymentTotal Registration Fees $0.00 Payment Type*Choose how you will register and payPay now by credit cardCreate an invoicePO NumberEnter your PO number if you have it. Or you can submit it to us later. Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name Please note that check or credit card payment is due by January 28th, 2019.