Morehead State University :: College of Education

Personal Information

First Name

Last Name

Name Preferred on Certificate of Participation

Home Address

City

State Zip Code

Gender Male Female

Home Phone

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Personal Email Address

EDUCATIONAL INFORMATION

School

School Address

City

State Zip Code

School District

School Phone

Will you be teaching an AP Class next year? Yes No

I give permission for my local newspaper to be notified of my participation in the AP Institute and Morehead State University

Yes No Name of Newspaper

Workshops

The registration fee for the AP Institute is $525 per person. There is an additional $50 lab fee for Chemistry and Environmental Science

Please Choose one of the following:

Method of payment

My workshop registration will be paid in the following manner. Please indicate if more than one of the following payment methods will be used. All checks should be made payable to Morehead State University and mailed to:

Advanced Placement Summer Institute

ATTN: Teresa Johnson

Morehead State University

100 Ginger Hall

Morehead, KY 40351

$50 LATE FEE REQUIRED FOR REGISTRATION RECEIVED AFTER FRIDAY, JUNE 14, 2013

The following information must be provided if your school district is to be billed for your registration

Contact Person:

Contact's Email:

Name of Office:

Address:

City: State: Zip Code:

Phone Number: Fax Number:

See APSI Information and Registration for registration deadlines and rules on Cancellations and Refunds.

Contact Information:

Tim Simpson, APSI Director, apsi@moreheadstate.edu

Phone: (606)783-2858 Fax: (606) 783-5032

Teresa Johnson, APSI Assistant Director, apsi@moreheadstate.edu

Phone (606) 783-2854 Fax: (606) 783-5032