Registration Form VISTA Fall 2007 to Spring 2008

Please Fill Out and Return with Your Registration Fee to:

TRE Center * Maywood School * 1979 Central Avenue * Albany, New York 12205

Name: __________________________________________________________________________________

Home Address: ___________________________________________________________________________

City:________________________________________________State:_____________Zip:_______________

School / Agency: __________________________________________________________________________

District / Region: __________________________________________________________________________

Supervisor: ______________________________________________________________________________

Position: ________________________________________________________________________________

Special Education Teacher Yes ____ No ____

Home Phone: ___________________ Work Phone: ___________________

Check if:

___ TRE ( ATIS ) Assistive Technology Itinerant Service District Staff

___ Capital Region BOCES Special Education Division EA / TA

___ Capital Region BOCES Special Education Division Employee

___ Parent / Sibling / Grandparent of Child with a Disability who is attending a BOCES class

Workshop (s) # , Date, Title

_____________ _____________ ____________________________________________

_____________ _____________ ____________________________________________

_____________ _____________ ____________________________________________

_____________ _____________ ____________________________________________

Amount on Check Enclosed $ ___________ Check # ___________

MAKE CHECKS PAYABLE TO: CAPITAL REGION BOCES

For additional information, call The TRE Center at (518) 464-6346 Fax: (518) 464-6353