University of Texas at Tyler
Advanced Placement Summer Institute
August 1-4, 2011

Registration Record

The following information has been submitted to the UT-Tyler APSI staff and a copy has been emailed to the address that you have provided.

NOTE: Your registration is not complete until payment has been processed.

You have indicated that your registration fees will be paid by PURCHASE ORDER PERSONAL CHECK DISTRICT CHECK CREDIT CARD

Please complete the payment section of this form and fax it to: 903-565-5988 (Fax) Purchased orders should be sent by fax or email using the contact information below:
ATTN: Georgia Glazebrook
RE: APSI Registration Email: gglazebrook@uttyler.edu
Fax: 903-565-5988 Checks should be mailed to:
Advanced Placement Institute
3900 University Blvd
BEP 229-C
Tyler, TX 75799
Attn: Georgia Glazebrook

Applicant Information
Name:
 #Trim(Form["FIRST_NAME"])# #Trim(Form["LAST_NAME"])#

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#Trim(Form["ADDRESS2"])#
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Home Phone: #Trim(Form["HOME_PHONE"])#
Work Phone: #Trim(Form["WORK_PHONE"])#

Email: #Trim(Form["EMAIL"])#
Email2: #Trim(Form["EMAIL2"])#
School Information:
 #Trim(Form["School_NAME"])#

#Trim(Form["SCHOOL_ADDRESS1"])#
#Trim(Form["SCHOOL_ADDRESS2"])#
#Trim(Form["SCHOOL_STATE"])#
#Trim(Form["SCHOOL_ZIP"])#
School Phone: #Trim(Form["HOME_PHONE"])#
School District: #Trim(Form["School_district"])#
Region ESC: #Trim(Form["Region_ESC"])#
Course Selection

SELECTED ________ AP Biology
SELECTED ________ AP Calculus
SELECTED ________ AP English Language & Composition
SELECTED ________ AP English Literature
SELECTED ________ AP United States History
SELECTED ________ AP Spanish

SELECTED ________ Pre-AP English Middle School
SELECTED ________ Pre-AP English High School
SELECTED ________ Pre-AP Math Middle School
SELECTED ________ Pre-AP Math High School
SELECTED ________ Pre-AP Science Middle School
SELECTED ________ Pre-AP Social Studies Middle School
On-Campus Housing Yes, I plan to lodge on campus No, I do not need on-campus lodging
Payment Information

A purchase order will be sent to secure my registration.

A personal check will be sent to secure my registration.

A check from my district will be sent to secure my registration.

I will fax a completed form with my credit card information after completing this registration.

Please charge my credit/debit card for the total amount. My credit card information is listed below.

*Visa, Mastercard, and American Express are accepted.

Card Type_______________________________

Card Number_____________________________

Card Holder______________________________

Exp. Date___________
UT-Tyler Advanced Placement Summer Institute

University of Texas at Tyler
Advanced Placement Summer Institute
August 1-4, 2011

Registration Form

Attendee Information
*First Name:
*Last Name:
 
*Address 1:
Address 2:
*State:
 (e.g. TX)
*Zip Code:
 
*Email:
*Re-type Email:
*Home Phone:
*Work Phone:
   
School Information
*School Name:
*School Address 1:
School Address 2:
*State:
 (e.g. TX)
*Zip Code:
*School District:
*Region ESC:
   
   
*Course Selection
  
 

AP Biology
AP Calculus
AP English Language & Composition
AP English Literature
AP United States History
AP Spanish

Pre-AP English Middle School
Pre-AP English High School
Pre-AP Math Middle School
Pre-AP Math High School
Pre-AP Science Middle School
Pre-AP Social Studies Middle School

 

 

*On-Campus Housing Reservation

Check if you plan to lodge on campus

Each 4-bedroom suite has 2 bathrooms, internet access, cable outlets (no TVs provided). Furnishings include: bed (extra long mattress, 80" long), desk, desk chair, couch, and coffee table. Kitchens include: stove, microwave, dishwasher, refrigerator w/ ice maker, and garbage disposal.

*Participants must bring all linens, pillows, towels, cooking utensils, dishes, and personal items.*
Rate per night is $24.00 per person.
   
*Payment Information

NOTE: Payment is NOT submitted online

Please indicate your payment preference below:

Confirmation of Registration

Upon receiving your completed registration and payment option, you will receive a confirmation email and invoice (if applicable) at your school address. If you have any questions or do not receive confirmation, please contact the AP Summer Institute at 903.566.7010 or gglazebrook@uttyler.edu

Refund Policy

Partial refunds will be issued for cancellations received in writing on or before 07/11/11. A $50.00 fee will be charged for any cancellations prior to this date. After 07/11/11, refunds will not be possible. No course changes will be made after 07/11/11. Registrations received after 07/11/11 will be accepted on a case-by-case basis due to the limited space available.

On-site registration and sign-in will be from 7:00am-8:00am August 1 in the UC Ballroom on the UT Tyler Campus where a continental breakfast will be served. We will be sending you updates via email leading up to the workshop, so please keep us posted if your email has changed. If you do not check your school email during the summer, please provide us with an additional email for which to reach you if necessary.

Please make sure you reserve a hotel or other lodging accommodations as soon as possible. The Sleep Inn of Tyler is a new hotel with some very nice features that has reserved several rooms for us at the government rate of $85/night. The phone number is (903) 581-8646 and request rooms under APSI-UT Tyler.

University of Texas at Tyler
Advanced Placement Summer Institute
August 1-4, 2011

Registration Record

The following information has been submitted to the UT-Tyler APSI staff and a copy has been emailed to the address that you have provided.

NOTE: Your registration is not complete until payment has been processed.

You have indicated that your registration fees will be paid by PURCHASE ORDER PERSONAL CHECK DISTRICT CHECK CREDIT CARD

Please complete the payment section of this form and fax it to: 903-565-5988 (Fax) Purchased orders should be sent by fax or email using the contact information below:
ATTN: Georgia Glazebrook
RE: APSI Registration Email: gglazebrook@uttyler.edu
Fax: 903-565-5988 Checks should be mailed to:
Advanced Placement Institute
3900 University Blvd
BEP 229-C
Tyler, TX 75799
Attn: Georgia Glazebrook

Applicant Information
Name:
 #Trim(Form["FIRST_NAME"])# #Trim(Form["LAST_NAME"])#

#Trim(Form["ADDRESS1"])#
#Trim(Form["ADDRESS2"])#
#Trim(Form["STATE"])#
#Trim(Form["ZIP"])#
Home Phone: #Trim(Form["HOME_PHONE"])#
Work Phone: #Trim(Form["WORK_PHONE"])#

Email: #Trim(Form["EMAIL"])#
Email2: #Trim(Form["EMAIL2"])#
School Information:
 #Trim(Form["School_NAME"])#

#Trim(Form["SCHOOL_ADDRESS1"])#
#Trim(Form["SCHOOL_ADDRESS2"])#
#Trim(Form["SCHOOL_STATE"])#
#Trim(Form["SCHOOL_ZIP"])#
School Phone: #Trim(Form["HOME_PHONE"])#
School District: #Trim(Form["School_district"])#
Region ESC: #Trim(Form["Region_ESC"])#
Course Selection

SELECTED ________ AP Biology
SELECTED ________ AP Calculus
SELECTED ________ AP English Language & Composition
SELECTED ________ AP English Literature
SELECTED ________ AP United States History
SELECTED ________ AP Spanish

SELECTED ________ Pre-AP English Middle School
SELECTED ________ Pre-AP English High School
SELECTED ________ Pre-AP Math Middle School
SELECTED ________ Pre-AP Math High School
SELECTED ________ Pre-AP Science Middle School
SELECTED ________ Pre-AP Social Studies Middle School
On-Campus Housing Yes, I plan to lodge on campus No, I do not need on-campus lodging
Payment Information

A purchase order will be sent to secure my registration.

A personal check will be sent to secure my registration.

A check from my district will be sent to secure my registration.

I will fax a completed form with my credit card information after completing this registration.

Please charge my credit/debit card for the total amount. My credit card information is listed below.

*Visa, Mastercard, and American Express are accepted.

Card Type_______________________________

Card Number_____________________________

Card Holder______________________________

Exp. Date___________
   

Confirmation of Registration

Upon receiving your completed registration and payment option, you will receive a confirmation email and invoice (if applicable) at your school's address. If you have any questions or do not receive confirmation, please contact the AP Summer Institute at 903.566.7010 or gglazebrook@uttyler.edu

Refund Policy

Partial refunds will be issued for cancellations received in writing on or before 07/11/11. A $50.00 fee will be charged for any cancellations prior to this date. After 07/11/11, refunds will not be possible. No course changes will be made after 07/11/11. Registrations received after 07/11/11 will be accepted on a case-by-case basis due to the limited space available.

On-site registration and sign-in will be from 7:00am-8:00am August 1 in the UC Ballroom on the UT Tyler Campus where a continental breakfast will be served. We will be sending you updates via email leading up to the workshop, so please keep us posted if your email has changed. If you do not check your school email during the summer, please provide us with an additional email for which to reach you if necessary.

Please make sure you reserve a hotel or other lodging accommodations as soon as possible. The Sleep Inn of Tyler is a new hotel with some very nice features that has reserved several rooms for us at the government rate of $85/night. The phone number is (903) 581-8646 and request rooms under APSI-UT Tyler.