Name:

Home Address:

City:                                                                        State:                                              Zip:

Phone:                                                                           email:

School District:                                                                                Campus:

Please circle the appropriate certification level you are seeking:

Level I                         Level II                          Level III                        Level IV                           Advanced Studies beyond Level IV

Please print and mail this registration, your payment or P.O. along with your parking registration (only necessary if staying on Texas Tech campus:

 Dee Ann Tackitt

3302 93rd Street

Lubbock, TX 79415

I have enclosed:

____ check $650

_____ P.O.

____ Money order for $650