Shepherd University Graduate Studies

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Bullying Workshop

Online Registration

Please register for the Bullying Workshop using the form below. If you have multiple people from your business who wish to attend, each person will need to complete an online registration form.

Workshop Fees:

$114 per 3 credits for teachers
$40 for non-teachers
$8 boxed lunch (optional)

*Fee includes 3 CEUs
(CEUs not available for non-teachers)

Workshop Information:

Morning Panel Presentations (choose one)

	A. Identifying and Preventing Bullying Behavior and Strategies for Resolution
	B. Bullying and GLBTQ Youth

	Boxed Lunch (optional)
Does this registrant have special dietary requirements? If so, please describe:

Afternoon Panel Presentations (choose one)

	A. The Social Aspects of Inclusion in the Classroom
	B. Cyberbullying: Why Kids Can't Ignore Its Devastating Effects

Registrant Information:

Salutation:

First Name:

Last Name:

E-mail:

Title:

Street Address 1:

Street Address 2:

City:

State/Province:

Zip/Postal Code:

Country:

Phone:

Cell:

Affiliation:

Does this registrant require special assistance? If so, please describe:

Emergency Contact Information

Name:

Relationship:

Phone:

Payment and cancellation policy

To make a credit card payment prior to the workshop, please contact Shepherd's Business Office at 304-876-5284. A payment made by money order or check must be written for the exact amount. All checks must be payable to Shepherd University. If mailing the payment, please send to the following address:

Shepherd University
c/o Enrollment Management
P.O. Box 5000
Shepherdstown, WV 25433

Payments may also be received the day of the workshop. Cash payment will not be accepted unless for the exact amount.

Receipt of the workshop fee will confirm a spot has been reserved for you.

Substitutions of business representatives may be made at any time. However, due to contractual obligations, limited space, and to anticipate attendance for the conference materials, a cancellation fee of 50 percent of the workshop fee will be assessed for cancellations received after April 22, 2012, or 100 percent for those who fail to attend.

Graduate Studies and Continuing Education | P.O. Box 5000 | Shepherdstown, West Virginia | 25443-5000 | 304-876-5313 | 800-344-5231