Registration Form   *Limited seating of 450* Registration deadline: July 10, 2010 (Late Registration: Additional $50 fee)   Participants should register by mailing this form along with payment to: Kansas Next Step 205 E. 7th, Suite 203 Hays, KS  67601     Name:          _______________________________________________________ Affiliation:    _______________________________________________________ Address:      _______________________________________________________ City:            _______________________________________________________ State:           _______________________________________________________ ZipCode:     _____________________________________________________________ Phone:         _______________________________________________________ Fax:             _______________________________________________________ Email:          _______________________________________________________   Certificate of Attendance Requested for Continuing Education__________________   My Company is interested in sponsoring next year __________________________                         Before       After                       July 10th   July 10th $_________   $250          $300     For the first person from the company $_________   $200          $250     For each additional employee from the same company $_________   $100          $100     For all students (Discounts available upon request)   $_________    Total Amount Enclosed (Send additional names on a separate sheet.)   Cancellations subject to a $50 non-refundable fee.   MORE INFORMATION: Deb Denning (785)432-7837   MAKE CHECK PAYABLE TO: Kansas Next Step, Inc.   MAIL TO:                              Kansas Next Step, Inc. Hadley Center 205 East 7th, Suite 203 Hays, KS  67601                                                                 Hotel group rates can be found at www.kansasnextstep.org. Please make your own reservations. Mention Kansas Next Step for group rates.