Registration Form

Invest North Dakota Teachers Academy
July 19 - 23, 2010

Location:
University of Mary
Bismarck, North Dakota

Items with an * are required.

*First Name:
*Last Name:
*Gender:	Male  Female
*School:
*Teaching Area:
	High School  Junior High (Middle School)  Elementary
*School Address:
*School City:
*School Zip:
*Home Address:
*Home City:
*Home Zip:
*School Phone:
*Home Phone:
Fax:
Email Address:

*Please check the University where you would like to obtain credit:

NDSU  UND  MiSU (Paperwork for credit at NDSU and MiSU will be completed at the time of on-site registration.)

UND registrants, go to http://educators.und.edu to register for credit online (check third party payment).

Dormitory On-Campus Housing:

Double  Single  I Have Other Arrangements

Note: We will make every effort to satisfy your room request if space is available for singles.

Arrival Date:	(Housing available 7/19, 7/20, 7/21, & 7/22)
Departure Date:

Roommate Preference (if desired):

(We recommend that housing be requested only by participants living more than 20 miles from seminar location)  Enclosed is my $50 reservation fee (payable to North Dakota Securities Dept.)   Enclosed is my $40 reservation fee (If postmarked by June 1, 2010) How did you hear about Invest North Dakota? Have you ever attended Invest North Dakota in the past?  Yes   No Do you currently include financial planning in your curriculum?  Yes   No

REGISTRATION DEADLINE IS JULY 9, 2010 THE SEMINAR IS LIMITED TO 150 PARTICIPANTS SO APPLY TODAY!

Click the button below to print this form and mail it to this address along with your deposit to: North Dakota Securities Department 600 E. Blvd. Ave. 5th Floor Bismarck, ND 58505