CONTRA COSTA

SPECIAL EDUCATION LOCAL PLAN AREA

 

 

 

WORKSHOP REGISTRATION FORM
Use only for Contra Costa SELPA sponsored events.
 
Registration deadlines are generally one week in advance of the event date. Although our wish is to accommodate all those who care to attend, space and materials may not be available for those who register after a workshop's deadline. Please check event flyers for specific registration dates.
 
Click here to register for 2016-2017 CAC Parent Training dates.
Main Registrant Information:
  First & Last Name:       Position:    
  District/Agency:       Site:    
  Email:       Phone:    
Workshop Name / Date:
Registration Fee:
   
OPTIONAL: For your convenience, you can register for two additional workshops below:
Workshop Name / Date:
Registration Fee:  
Workshop Name / Date:
Registration Fee:
   
  Method of Payment: check*   P.O.
#
   
 

In order to receive the CCSELPA registration rate, you must work for, with or within one of the
Contra Costa SELPA member LEAs:
Acalanes, Antioch, Brentwood, Byron, Canyon, Contra Costa County Office of Education, John Swett, Knightsen, Lafayette, Liberty, Martinez, Moraga, Oakley, Orinda, Pittsburg, and Walnut Creek.

OPTIONAL: ADDITIONAL REGISTRANTS (if any) You may register up to three more people for the same workshop(s) below:
#2 Additional Registrant      
 
First & Last Name:
Email:
       
 
Position:
Site:
       
         
#3 Additional Registrant    
 
First & Last Name:
Email:
         
 
Position:
Site:
       
           
#4 Additional Registrant    
 
First & Last Name:
Email:
       
 
Position:
Site:
       
                   
Any Additional Information or Comments:  

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Due to the volume of registration received, registration confirmation is only sent upon request. You will not be contacted regarding your registration unless there is a change or cancellation. If you wish to confirm your registration, you may follow up by phone to 925-827-0949, 10 or by email.

REGARDING WAITLING LISTS:
If you have placed your name of the waiting list for a workshop that is full, you will only be contacted if there is an opening. Please be sure to include a phone number or email address where you can be reached during the day.
 
ADDITIONAL INFORMATION REGARDING REGISTRATION:
72-hour cancellation notice is required for refund, unless otherwise noted (M-F). Substitutions are welcome, please call in advance.
If you have any questions, want to confirm or cancel your registration, please send an email or call (925) 827-0949, ext. 10.
Workshops may reach capacity early or be cancelled due to lack of registration. Please register early to guarantee your spot. Advance payment not required.
 
REGARDING PAYMENT:

Payment is not required in advance unless otherwise noted. Payments by purchase order, cash and check can be made directly to CC SELPA by mail or at the workshop. A receipt for payment of registration fee is available upon request.

Credit card payments are only available through Eventbrite and will include Eventbrite's online service fee. See our Eventbrite workshop page here: http://www.eventbrite.com/o/contra-costa-selpa-7601852063

Mail and payments should be directed to:

Contra Costa SELPA 2520 Stanwell Drive, Suite 270 Concord, CA 94520

Be sure to include with your payment the name and date of the workshop for which you have registered.