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Download this form as a .pdf file or print this form and send to CANEC

CALIFORNIA CHARTER CONNECTION

CANEC STUDENT SUMMIT

REGISTRATION FORM

March 29, 2003

Anaheim Marriott, Anaheim

8:00* a.m. – 3:30 p.m.
* Please note new start time. The event will begin at 8:00 a.m. and not 9:30 a.m. as was previously advertised.

(Please type or print legibly)

One person per registration form.

Name: _________________________________________________________________

School: _________________________________________________________________

Street Address: __________________________________________________________

City/State: ______________________________________________________________

Zip Code: ______________________________________________________________

Telephone: ____________________________ Fax: ____________________________

E-mail: ________________________________________________________________

Special Access or Dietary Needs: ___________________________________________

Favorite Pizza Topping (circle one): cheese pepperoni other_________

Grade Level (circle one): 9 10 11 12

Optional Information:

· Favorite aspect of your charter school

· Favorite subject

· Favorite band or musical group

· Favorite past time

· Special talents

· Post high school goals

Return this form postmarked by March 15th to: CANEC, 744 El Camino Real, San Carlos, CA 94070 or fax to (650) 654-4267 or email to CANEC2001@aol.com.

Participation granted on a first come, first served basis.