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KET Multimedia Professional Development Days 2012

Registration Payment Form

(See Event Details for more information.)

Please complete the form below and print this page. Then return the completed form with your payment or purchase order within two weeks. (You can type into the form fields online before printing.) Or you may download a printable (PDF format) version.
Registrants whose payments or purchase orders are not received within two weeks of their registration may be removed from the event list to make room for others.

Mail this payment form to:

KET Multimedia PD 2012
ATTN: Cynthia Barton, Event Coordinator

600 Cooper Drive
Lexington, KY 40502-2296

Questions? Call or e-mail Cynthia at (800) 432-0951, ext. 7271; (859) 258-7271; or .

The registration fee of $50.00 per person, per day, includes lunch and refreshments.

Date Registered:

: $50.00
: $50.00
: $100.00

Would you like us to add your e-mail address to the list to receive updates about Jeff Gray's MediaWorks blog on school multimedia production at

If you will not be checking your school mail or e-mail during the summer break, please provide an optional address where we may contact you:

Method of payment (check one):

If paying by credit card:

I give KET permission to use video or audio recorded by KET during the KET Multimedia Professional Development Days 2012 in any later KET-produced video, audio, or Internet projects, including web pages and Internet video streaming.

Signature of participant




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