2005 Professional Development
Please fax this form to: (914) 592-4727

Administrator    Support Staff    Classroom Teacher

District: _____________________________________________      Date: ________________________

Contact Person: _______________________________________       Phone: _________________

Fax: _______________________     E-mail: ___________________________________________

• Your district will automatically be billed a cancellation fee of $100 if a cancellation notice is not received via fax (914) 592-4727 at least 3 working days prior to the class date.

Name: __________________________________________________________

Canceled  Workshop: _____________________________________________     Date: _________________

Canceled  Workshop: _____________________________________________     Date: _________________

Canceled  Workshop: _____________________________________________     Date: _________________

 

• Our receipt of this form confirms workshop cancellation

*Authorized by: _____________________________________________             Date: ________________
                                           (please print name)

Signature: _____________________________________________________________________



* Administrator, Technology Coordinator or District Contact