KENTUCKY DRIVER TRAINER ASSOCIATION

Leading the Way in the Safe Transportation of Kentucky Children

Registration Form

2010 Summer Conference

July 11 – 14, 2010

Galt House Hotel

Louisville, Kentucky

Phone: 1-800-843-4258

Last Name: ___________________First __________________________MI:______________________________

Title: _____________________________________________Phone Number _____________________________

District/Organization Name: ____________________________________________________________________

Address: _____________________________________________________________________________________

e-mail _______________________________________________________________________________________

Signature ____________________________________________________________________________________

Amount:

________ 95.00 (includes yearly membership fee and Conference Brunch)

________ Extra Meal Tickets (30.00 each)

________ Mechanic Classes Only (50.00)

________ P. O. Number

Please send to: David Jones

Adair County Schools

1204 Greensburg Street

Columbia, KY 42728

Phone: (270) 384-2476 Fax: (270) 384-5841 e-mail: david.jones@adair.kyschools.us

You may download this form from the KDE website (go to www.education.ky.gov) and choose "Administrative Resources" from the toolbar across the top of the page, then click choose "Transportation" from the column on the left, then choose 2010 Summer Conference" and click on 2010 Summer Conference Registration Form"

Registration form is also located on the Kentucky Driver Trainer Association website (go to www.kdta.net).