Texas Lutheran University

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STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

Thank you for choosing to attend Advanced Placement Summer Institute at Texas Lutheran University. We appreciate your support and commitment, and anticipate another successful APSI event.

How to Enroll:

Complete the following form online by inputting the required information in each block of the form.
The online enrollment form MUST indicate your method of payment: check, purchase order from your school, or credit card (which has to be processed at the time of registration).
A “Payment Method” has to be completed in order to proceed.
Click “Proceed to Confirmation” upon completion.
Notification that registration has been completed will be sent immediately to the primary email address provided on the form.
Registration is not confirmed until the full payment is received.
The ‘Participant Packet’ will be sent to the same email address one week prior to the event.

IMPORTANT INFORMATION/DETAILS

Early Bird Registration is $570.
After May 27 - Late enrollment will be subject to an additional $50 processing fee, for a total of $620 registration.
Changes after June 25, will need to be submitted by email or mail, see below:

ALL changes must be sent in writing via e-mail or mail before the deadlines listed above.
NO telephone changes will be accepted

Refunds on cancellations, minus the $120 processing fee, will be given through June 25.
After June 25 - Cancellations and No Shows will not be refunded.

All registrations must be paid by June 30. Completion certificates will not be distributed until paid in full.

Select if Paying by eCheck or Credit Card

Qty

Description

Amount

Total

Registration - Paying by Credit Card

$620.00

---

Select if Paying by Purchase Order

Qty

Description

Registration - Paying by Purchase Order

Select if Mailing in a check/Money Order

Qty

Description

Registration - Mailing in a Check/Money Order

(without PO)

Total: $0.00

Purchase Order
**If you are using a Purchase Order, please fill out the following information

You do not need to fill in credit card information at the end of the form.

Purchase Order Date:

Purchase Order #:

Purchase Order School District:

Applicant Information

First Name: *

Last Name: *

Gender:

Home Address: *

Address 2:

City: *

State: *

Zip Code: *

Telephone: *

Cell Phone:

Summer Email: *

Confirm Email:

Currently Teach:

Years of Experience:

School Information

School Name: *

School Address: *

School City: *

State: *

Zip Code: *

School Phone: *

School Fax:

District Information
If your school does not fall within a district please enter N/A

District Name: *

District Address: *

District City: *

State: *

Zip Code: *

District Phone: *

District Fax:

Week 1 Courses:
(July 5-8)

Week 2 Courses:
(July 11-14)

Attended APSI at TLU before?

Dietary restrictions/preferences?

Diet Information:

Do you have any special needs?

Special Needs Requests:

Comments:

Payer Information

First Name: *

Last Name: *

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Telephone: *

E-mail: *

A receipt will be e-mailed to this address.

Please fill information below if you are paying by credit card or echeck.

Your Payment Information

Name on Card:

Card Number:

Security Code:

Expiration Date:

Name on Account:

Routing Number:

Account Number: