Please provide the following information:

Annual PALS  State Conference

(Check applicable conference)

High School Conference

Middle School Conference

School Name
District Name
Teacher
Street address
Address (cont.)
City
State
Zip code
Telephone
                  FAX
              E-mail

Adult Sponsors:

SPONSOR NAME

SPONSOR NAME

1

2

3

4

5

6

Participating Students:

STUDENT NAME

STUDENT NAME

1

2

3

4

5

6

7

8

9

 10
11 12
13 14
15 16
17 18
19 20
21 22
23 24
25 26
27 28
29 30
31 32
33 34
35 36
37 38
39 40

 

Total amount for sponsors @ $55.00 each=
Total amount for students @ $35.00 each= 
Please indicate total amount                          

Please indicate comments below.

Note: T-shirts will be available at the conference for $12.00. If you wish to pre-order
your T-shirts, please indicate sizes and include the cost in your check amount.

Please make checks payable to:                       Additional Information:

Prevention Education Associates, Inc.              Kenneth Serrano        
7101 Highway 71 West                                        512-288-9760 (voice)
Suite 200                                                                512-394-0996 (Fax)
Austin, TX 78735                                                    512-970-8489 (Cell)
                                                                                 serrano@educating.org (e-mail)
                           

                                                  

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