Registration Deadline: Tuesday, January 17, 2012

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2 0 1 2 High School Student Convention on

Arizona's Centennial and Future

February 18-19, 2012 * The Marriott Hotel, Tucson, AZ

Co-Sponsored by the Arizona Junior State of America and The University of Arizona

Government and Public Policy Department

Underwritten by a generous grant from the Melody S. Robidoux Foundation

R E G I S T R A T I O N P A C K E T

Registration Deadline

:

Tuesday, January 17, 2012

The student leaders of the Junior State of America and the Government and Public Policy Department of the

University of Arizona cordially invite you to participate in the

2012 High School Student Convention on

Arizona's Centennial Future

. We hope that you will be able to join hundreds of students and teachers for an

exciting educational experience.

What is the 2012 JSAZ Centennial Convention?

February 2012 marks Arizona's one hundredth year as a state. JSA, and its partner the University of Arizona,

School of Government and Public Policy are using the centennial anniversary as a launching pad for interested

high school students and teachers to come together to seek answers to the following questions:

What in our

history makes us unique? or What makes us Arizonans?

And,

What do Arizona's future leaders think

about major issues facing Arizona?

Through a two-day series of discussions with University of Arizona faculty and student debates, Centennial

Convention delegates will produce a Platform expressing youth opinion on Arizona's future. Delegates will be

encouraged to share this important Platform with their school principal and school board, as well as the local

media. In addition, the Platform will be presented to Governor Brewer, Arizona's state legislative leadership,

and elected city, county and school officials statewide.

Convention Overview

Saturday, February 18, 2012

Arizona students who live outside Pima and Santa Cruz Counties will be picked up at their schools (or a

convenient nearby location) early Saturday morning and transported by luxurious chartered buses to Tucson.

This free transportation is covered by a grant from the Melody S. Robidoux Foundation. There will be buses

from Flagstaff, Phoenix, and Yuma (and lots of locations in between). Pima and Santa Cruz County delegations

will travel to the Convention in teacher/parent carpools or other school-arranged and approved transportation.

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Saturday, Day 1 –Overview - Campus Tours - Student Debates - Teacher Reception

Delegates will register at the luxurious Marriott Hotel University Park in Tucson. Following registration, we

will walk together in groups to the University of Arizona (adjacent to Marriott Hotel) for Opening Session and a

full day of educational activities.

Opening Session

features guest speakers with a special interest in Arizona history, politics, law or economics.

Following Opening Session, delegates be divided into five sections and take a

campus tour

followed by lunch

on your own in the lively area surrounding the University of Arizona. After lunch, your

group section

will meet

with University of Arizona

faculty in an academic lecture/discussion where you will try and answer the

question,

What is there about our state's past that makes us uniquely Arizonans?

The goal of these section

discussions is to set the stage for student debates that follow and to give delegates a chance to start formulating

and expressing their own opinions. Faculty lectures will focus on one of five areas:

Education, People, the

Environment, the Economy, or Law and Governance.

Each small section will be led by a U of A faculty

member and a high school student chair. Students interested in serving as a Section chair should contact JSAZ

student Governor, Caleb Rhodes at crhodes@jsa.org.

In each of five sections, delegates will be challenged by topics which offer alternatives to solve a particular

issue. The topics offer students an opportunity to take on controversial issues facing state and national leaders

today. In the debates, pre-selected students will start by giving speeches outlining the strengths of their

alternative. These opening speakers focus on the strongest reasons for passing the various alternatives.

Following these opening speeches, students in the audience may volunteer to speak for the side they support

with subsequent speeches of up to 3 minutes in length. When time has run out or there are no more students

who want to speak, the chair will close debate and invite the proponents to make final speeches summarizing

the strongest reasons to vote for their alternative. Once these speeches have been given, the audience votes and

the winning alternative will be presented for adoption by the entire group on Sunday.

The alternatives that are adopted by the general assembly of delegates on Sunday will make up a

Platform of

Arizona Youth Opinion.

Teachers and other advisors will be feted at a

special Teachers Reception

hosted by JSA and the University of

Arizona on Saturday afternoon. This reception offers an opportunity for informal sharing of ideas and best

practices for guiding and encouraging outstanding high school students to become civically engaged. It is also a

way for the co-sponsors to thank advisors for participating in this educational program.

Saturday evening Activities – Presidential Election Forum, Dance, Recreation and More

Students will have the opportunity to express their opinion on the 2012 candidates for President during a

Presidential Forum on Saturday night. During recreational hours, delegates may socialize with their peers at a

JSA Centennial dance, or work out in the hotel gym, or swim in the hotel pool.

Sunday, Day 2 – Creating the Platform of Arizona Youth Opinion - Luncheon Banquet

Delegates will meet in general session to consider and vote on the debate resolutions that were passed on

Saturday in the small group sections. Through this process, a Platform will be created of Youth Opinion on the

future of Arizona. A banquet with major guest speakers will conclude the two-day program. Awards will be

given for best speakers.

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QUESTIONS OR PROBLEMS?

Please contact the Junior State office and/or student leaders by phone or e-mail for additional information.

Convention Planning and Programming Questions:

Karen Prosser, Arizona JSA Program Director

kprosser@jsa.org

(650) 393-7654 or (800) 334-5353 Ext. 7654

Convention Student Leadership Assignments Sign-Ups

(E.g. debate chairs, main debater sign ups, etc.)

Caleb Rhodes, JSAZ Governor

crhodes@jsa.org

The Junior Statesmen of America is a Voter Education & Outreach Partner with the National

Association of Secretaries of State.

CONVENTION FEES

STUDENTS

We are pleased to announce a special convention fee of

$60 per student

for those who register online.

Chapters may register via paper for an additional $10 per person fee. The registration fee includes:

Hotel lodging for one night in the Marriott University Park, Tucson

Round trip transportation by chartered bus for Arizona delegations from outside the local area (Pima

and Santa Cruz Counties)

Banquet Luncheon on Sunday

Educational materials and activities on the University of Arizona Campus

Social events on Saturday night including a 2012 Presidential Forum and a Dance

If you would like to start a Junior State chapter at your school, follow the steps outlined in the Junior State

Chapter Start Up Guide (available at jsa.org/downloads or call the Junior State office). Collect $3.00 in taxes

(dues) from at least eight (8) students at your school and fill out a tax form.

Every member will receive a Junior State membership card and Junior State literature will be mailed to him/her

throughout the year. Mail the tax form and a check for a minimum of eight members ($24) to the San Mateo

Junior State office. A current Junior State chapter should not submit any non-member registration fees. Every

convention delegate from your chapter must be a tax paid member. These forms are available online at

http://www.jsa.org/downloads or in the “Downloads” section of the website.

Please mail your taxes separately

from your convention registration

, as this makes it easier for us to

accurately process them. If necessary, we can accept taxes mailed with your convention registration, but they

must be in

two separate checks

.

Do not send cash

.

All members of your chapter do not have to attend the convention. Also, you may add members any time during

the year by sending their taxes and a new tax form. If you have questions about starting a chapter, please call

JSAZ Program Director Karen Prosser at the Junior State office at (650) 393-7654 or toll free at (800) 334-5353

ext. 7654. Students from other schools

MAY NOT

attend the convention as part of your delegation. Friends

from other schools should be encouraged to form their own delegation.

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TEACHERS/ADVISORS

All delegations of students must be accompanied by 1 teacher/advisor from their high school for every 19

students.

We are very pleased to offer the convention free of charge to teacher/advisors.

We will provide one free

teacher/advisor registration (double accommodations: two teacher/advisors of the same gender housed in a

room with two queen-size beds) for every teacher/advisor who brings a delegation of between three (3) and

nineteen (19) students.

Delegations of 20 - 39 are required to bring two teacher/advisors, both free of charge; 40 - 59 must bring three

etc., all free of charge. The ratio of students to teachers/advisors cannot exceed nineteen to one.

Private rooms (instead of double accommodations) for a teacher/advisor (or a teacher/advisor with spouse) are

available for

$95.

Teacher Registration includes:

Marriott University Park Hotel room for 1 night

round trip bus transportation from outside the local area

a special Teacher reception

a Banquet Luncheon

CONVENTION DETAILS & REGISTRATION

Location:

Marriott Hotel University Park

880 E. Second Street

Tucson, AZ 85719

(510) 792-4100

Registration:

Saturday morning, February 18, 2012

8:30-10:00 a.m.

Adjournment:

The convention ends, February 19 at 3:00 p.m.

Online Registration Fee

Paper Registration Fee

Student Fees

Student Member – online registration

Registration Fee includes bus transportation (for delegations outside Pima &

Santa Cruz Counties), educational program, recreation, the dance, Luncheon

Banquet, and lodging in the Marriott University Park Hotel.

Late Fee

FREE

$10 per person

$60

$10 per student

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Tucson, AZ 85719

(510) 792-4100

The 2012 High School Student Convention on Arizona's Centennial and Future

is designed for high school

students interested in participating with their peers in provocative discussions of important current issues. All

student participants from your high school and your teachers/advisors will register together as one delegation.

When looking for students to join your delegation, you should approach politically aware students like students

involved in JSA, Forensics, Model U.N., or YMCA Youth and Government. Student government officers, your

high school’s newspaper staff, speech and debate team members, and honor society members may also be

interested in attending. History, government, and social studies teachers may wish to bring an entire class.

The Registration deadline is Tuesday, January 17, 2012. Late registration will be accepted, space

permitting.

REFUND POLICY

Because we have to make guarantees to the hotel far in advance of the convention, we are unable to make refunds after the registration deadline has passed. If you send in a copy of documentation and a guarantee that a school check is being processed, you will be held to your original headcount and will not receive a refund for any students who cancel.

We encourage paid delegates who find themselves unable to attend to find another student from their school to go in their place and have the new delegate reimburse them for the registration fee. Each replacement student MUST submit a permission slip.

Notify the Junior State office at (800) 334-5353, Ext 7654 as soon as you make the switch in delegates. With teacher/advisor approval, we can ensure that appropriate housing arrangements are made, which are especially necessary if you switch a male for a female.

We are happy to accommodate students or teachers who require special arrangements due to a physical disability or handicap. Delegates must make those arrangements with the Junior State staff as soon as possible.

Students who wish to register after the deadline must get approval from the teachers/advisor accompanying their delegation to the convention.

FUNDRAISING

We hope that every delegation is actively raising funds to lower the convention price for all of its members. Fundraisers can be fun delegation-building activities. There are many groups and individuals in your community who would be eager to help your delegation attend the convention if they just knew about it. In addition, JSA has created an online fund raising module to give delegations a chance to fund raise as a team. Please contact Karen Prosser at kprosser@jsa.org or your Governor Caleb Rhodes at crhodes @jsa.org if you would like more information on successful fund raising.

Teacher Fees

T/A in a Shared Room (1 advisor for 3-19 students) (Teacher Package 1)

Registration includes bus transportation (for delegations outside Pima &

Santa Cruz Counties) lodging in the Marriott University Park Hotel, a special

Teacher Reception and Banquet Luncheon. Teachers with 1 to 2 delegates

pay $95.

T/A in a Private Room (Teacher Package 2)

Registration includes bus transportation (for delegations outside Pima &

Santa Cruz Counties) lodging in the Marriott University Park Hotel, a special

Teacher Reception and Banquet Luncheon.

FREE

$95

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HOUSING

Housing assignments for the convention are made by the hotel with the following guidelines: The hotel is given a list of delegates in groups of four, as you have indicated on the rooming list sent to the Junior State office. The hotel staff houses students in rooms of four people (with two large double beds), trying to keep delegations together and the teachers/advisors as close as possible.

If a delegation has fewer than four students of one gender, the hotel will house two or more delegations together to fit the room. Please tell your students that they could be sharing a bed with a student from another delegation. Teachers/advisors are housed two to a room (two beds) unless they arrange for a private room. Requests to room with a particular colleague will be accommodated whenever possible.

CONDUCT

Students, under the supervision of their Teacher/Advisors, are responsible for their own conduct. Convention rules are the same as for any school trip. An explanation of the rules and policies of The Junior Statesmen Foundation toward convention conduct is printed on the enclosed permission slip.

Any serious breach of these rules will result in appropriate punishment. Parents, school principals, and Teacher/Advisors will be notified of any student’s misbehavior.

Chapters are expected to screen prospective delegates. You are responsible for the delegates you bring. Select them carefully.Convention attendance is a privilege, not a right. Teachers should only bring delegates who have a history of good conduct and who have demonstrated their serious interest by attending chapter meetings.

Delegates must attend all convention activities. We strongly recommend that each delegation have a pre-convention meeting with students and parents to go over convention rules, debates, and travel.

DRESS CODE

Because we will be meeting in a luxurious hotel and with faculty on the University of Arizona Campus, students are encouraged to wear professional attire (appropriate for a job interview) during the convention. No short skirts, tennis shoes, tee shirts, or jeans during the daytime program events. Students should be aware that Members of the United States Congress are not permitted on the House or Senate floors unless they are appropriately attired.

Students may dress much more casually during the evening recreation hours. The Marriott Hotel offers a

swimming pool and workout gym which will be available to delegates in the evening hours.

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LEADERSHIP POSITIONS ARE AVAILABLE

Centennial 2012

(Optional)

Return application by January 17 to:

JSAZ Governor Caleb Rhodes, crhodes@jsa.org

As a student-run program, Centennial 2012 has many leadership positions open to student delegates. These positions will be selected prior to the convention. The Debate Chairs (moderators) will preside over the Debates. If you wish to apply for one of these

prestigious positions, you MUST highlight your experience with Parliamentary Procedure and leadership positions you have held on the application below. A familiarity with Roberts Rules of Order is essential.

Additionally a number of main debaters will be needed. Main debaters lead the debate as the Proponent. Proponents are responsible for an opening and closing speech during the debate on Saturday afternoon. If their side is the winning one, they will also present that resolution to the general assembly on Sunday for consideration. If the resolution is adopted on Sunday, it will be part of the Platform of Arizona Youth Opinion.

APPLICATION FOR A LEADERSHIP POSITION

Name___________________________________________________________________ HS Grad Year _____________________ Address____________________________________________________________________________________________________ City_____________________________________________________________ State________________ Zip_________________ Home Phone ( __ __ ) __________ E-Mail Address _______________________________________________ High School________________________________________________________________________________________________ I am interested in the following position(s):

_____ Debate Chair (Moderator)

_____ Main Debater (Debate topics will be published on December 21, 2011 and available online at JSA.Org in the downloads section for the Arizona Centennial)

Have you attended a JSA Convention before? _______ Yes ________No If yes, have you been a main speaker or a Debate Moderator in a JSA Debate? Main Speaker _____Yes _____No

Debate Moderator _____Yes _____No

How would you classify your debate experience? ____Very experienced ___Somewhat Experienced How would you classify your moderating experience? ____Very experienced ___Somewhat Experienced

Why are you interested in and/or how are you qualified for this position? ____________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________

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The Junior State

800 S. Claremont St, Suite 202, San Mateo, CA 94402 PARENTAL PERMISSION FORM

CALL (800) 334-5353 TO OBTAIN A CONVENTION BROCHURE or VISIT WWW.JSA.ORG FOR MORE INFORMATION.

Parents: Please read this information carefully and review it with your child before signing.

Your child should have a very exciting educational experience at the upcoming Junior State event. He or she will have an opportunity to debate current issues. We hope you have read the convention brochure, which lists the topics to be discussed. In advance of the event, your child should do some special reading to prepare for these debates and other educational activities. Please review the convention rules with your son or daughter. By sending your child to the convention, you agree to pick him or her up at your own expense if these rules are violated. Rule violators are sent home and are reported to their schools for appropriate disciplinary action. If you have any questions about the rules, travel arrangements, or the educational program, please call The Junior State office at 800/334-5353 ext 7654.

CONVENTION RULES

1. All rules for school field trips prevail. Use of illegal drugs or alcohol is not permitted. Students also will be punished if they are in a room where drugs or alcohol are present. The use of tobacco products is not allowed. To ensure these rules are obeyed, the Teacher/advisor and The Junior Statesmen Foundation must approve the attendance of each delegate. We reserve the right to deny any student the privilege of attending the event.

2. At 8 p.m., students will meet with their Teachers/advisors for roll call and may not leave the hotel thereafter. At curfew, Teachers/advisors will check delegates at their rooms. Delegates must remain quietly in their own rooms after curfew. Pizza deliveries and room service deliveries are not permitted after curfew. Delegates also are required to meet with the Teachers/advisors at other designated times.

3. Delegates must attend all conference activities.

4. At no time may young men and women be in each others' rooms.

5. Delegates may not leave the convention hotel without the permission of their Teachers/advisors. During meal times, with their Teachers/advisor’s permission, delegates may leave the hotel to eat in designated areas. Under no circumstances are delegates to leave the hotel after 8:00 p.m.

6. All students assigned to a room are responsible for any charges made to the room. All students assigned to a room are also responsible for the condition of the room. No outside phone calls can be made from student hotel rooms. Room service and other items may not be charged to a student’s room. No delegate may change rooms without the permission of a Junior Statesmen staff member at the event. The hotel staff will house four students in each room with two large double beds.

7. No student may drive a car to the convention or ride in a student driven car during the convention.

8. Visitors are not allowed in the convention hotel. Delegates are not allowed to associate with any visitor who is not an official guest of the Junior Statesmen program. 9. Students must always conduct themselves according to the highest standards of behavior. They must be considerate of and respect the rights of other delegates, staff, teachers/advisors, and other hotel guests. Students may not open, throw anything out of, or shout out of windows. Students must stay off balconies, roofs, and out of all restricted areas. All public laws must be complied with. Reasonable and due care shall be exercised by all students to ensure safety, good order, and to preserve the good reputations of their respective schools and the Junior State of America.

10. Students should not bring expensive items to the convention. Valuable items must be stored in the hotel safe or with the bellmen. The Junior State/The Junior Statesmen Foundation are not responsible for items stored in a luggage storage area.

11. Delegates that voluntarily withdraw from the convention, or that are sent home for conduct problems, will not receive refunds. 12. Delegates and their parents agree that The Junior State may use any photographs taken during the convention for promotional purposes.

--- ---

I agree to abide by all of the Junior State convention rules under the terms described on this permission form. I understand that in the event of a serious violation of the rules, my parents and my school will be notified, and I may be sent home at my own expense without a refund.

X

X_________________________________________________________________________________________________________

Student Signature Print Name Date

I agree to the terms described on this permission slip and give my child permission to attend the upcoming Junior State convention under those terms. The Junior Statesmen Foundation has my permission to obtain emergency medical treatment for my child at my expense.

X

X_________________________________________________________________________________________________________

Signature of Parent or Guardian Print Name Date

STUDENT NAME_____________________________________STUDENT EMAIL ___________________________

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HIGH SCHOOL ________________________________________________

GRAD YEAR _______________

SEX: ____MALE ____FEMALE

ADDRESS_______________________________________________CITY_________________ZIP_______

HOME TELEPHONE_______________________ CELL PHONE____________________________

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Online Group Registration Guide

Step 1: For any registration, check with the appropriate official at your school about any school approval that needs to be arranged. Do this well in advance to allow time for obtaining approval.

Step 2: All delegations should register for the convention online at www.jsa.org/myjsa. There is a $10 per person paper

registration fee for delegations that do not register online. For large delegations the paper registration fee can be hundreds of dollars, so don’t waste your money - register online! Make sure that all of the students and Teacher/Advisors that plan to attend the Centennial are registered on MyJSA at www.jsa.org/myjsa, and that each person’s contact information is correct and complete. To use the web-based registration system you must be designated as a Chapter President, Student Delegation Leader or Teacher/Advisor in our membership management system. If you are not so designated, please contact the Arizona Program Director Karen Prosser at 650/393-7654 or kprosser@jsa.org.

Step 3: Complete all of the forms in this registration packet as a guide for your online registration. Even though you will be registering online, it provides useful logistical information, as well as a set of the rules and other pertinent information.

Step 4: Make sure you have access to Chapter Management online at MyJSA. Go to www.jsa.org/myjsa and confirm that you have access to the chapter management features. If you are the Student Delegation Leader, Chapter President or Teacher/Advisor you should see a "My Chapter" option on the home page after you log in. If you do not see this option, contact Karen Prosser at 800/334-5353 ext 7654.

Step 5: Update your chapter roster. Make sure your entire new and returning chapter members are listed under your membership roster in our database. We recommend that you bring a computer with an internet connection to your next few meetings, and have members fill out a new member form online if they are not already listed on your membership roster. You should have all members entered into our database. Even if you do not have a JSA chapter, all of your convention delegates must be entered

individually into the JSA database.

Step 6: Collect registration fees and permission slips. As soon as possible you should begin collecting Centennial registration fees and permission slips from all of your members who will attend the convention. Keep track of who has paid and who has submitted permission slips using the forms in your registration packet or a spreadsheet on your computer.

Step 7: Create a rooming list. Once you know all the members of your delegation, use the rooming list form in the registration packet to note who will room together. If you have registered online, the system will provide you with a rooming list section which will have directions on it. If you do not have this information, please contact your Karen Prosser and she will help you.

Step 8: Calculate the total cost for your delegation. Use the instructions in the registration packet to calculate the total cost for your delegation, including student registration fees and any fees for teacher/advisors.

Step 9: Log in and submit your registration for your delegation.

Log into MyJSA. The online registration formwill ask for the information that you have assembled above, namely: a) your Chapter President or student delegation leader,b) your Teacher/Advisor, c) all of the students and adults who will attend as part of your delegation. The students and adults that you register are selected from your chapter roster;this is why it is important to make sure your roster is complete, as described above in Step 4. A day after submitting your registration online you will receive an online invoice, which shows the total amount due and yourdelegation list.

Step 10: Send in your payment, rooming list, and permission slips to the Junior State of America San Mateo office. If you are paying for your delegation by credit card, you can call the office to supply the credit card information.

Housing

Four students of the same sex are housed in a room with two beds; make sure all of your delegates are aware of this.

In cases where a delegation has fewer than four students of one sex assigned to a room, delegates from another high school will be housed with your delegates in that room.

Elected and appointed JSA student officers (approved by the Program Director) who may be rooming with other officers MUST be included in your delegation's registration:

List the student officers separately on the Rooming List Form and send your Program Director a confirming email about their arrangements to room with other officers. Student officer permission slips should also be sent with all of the others from your delegation.

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Students who need special arrangements due to a physical disability or handicap must make those arrangements with The Junior State headquarters staff as soon as possible.

What to Submit After Completing Your Online Registration

(Make a copy of each item for your records)

Permission slip for each student, signed by the student and a parent or guardian. Please, make copies of the blank permission slip from this packet and give to delegates or request extras from the JSA Office. Please do not fax signed permission slips to the JSA office.

Payment in full for each registered student (see Payment Options below) or evidence that you've made arrangements to have a check sent, such as a Purchase Order. Don't postpone submitting your registration materials if there will be delay in the school issuing a check. Submit your materials with a Purchase Order number issued by the school, or fax us a copy of the check request submitted to your school accounting office.

Payment in full for membership taxes and a completed tax form: (http://www.jsa.org/download/taxformpaymentonly.pdf)

Payment Options

1)

School Check: ONE inclusive check payable to The Junior State from the school. If your school cannot process your check request before the registration deadline, fax a copy of the documentation showing that you have arranged with the school to send the check, plus a guarantee from the school that payment will be received before the start of the convention

.

2)

Personal Check: ONE inclusive check payable to The Junior State from a parent or teacher (delegates will pay that individual).

3)

Credit Card: JSA will accept credit card payments for registration by phone. Please call (800) 334-5353

.

4)

Purchase Order: A school purchase order (must be payable within 30 days of registration deadline).

Do not send individual personal checks from the delegates.

Do not send cash.

Your delegation will not be registered until payment is received in one of the forms listed above

.

WHERE TO SEND FORMS AND PAYMENT

The Junior State of America 800 S. Claremont St. Suite 202 San Mateo, CA 94402

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ARIZONA CENTENNIAL REGISTRATION FORM

(To be used as a guide before registering online)

HIGH SCHOOL _________________________________________________________ TODAY'S DATE ___________________

STUDENT DELEGATION LEADER TEACHER/ADVISOR (Use separate sheet for additional T/As)

___________________________________________ ___________________________________________ NAME GRAD YEAR NAME

__________________________________________ __________________________________________ HOME ADDRESS SCHOOL ADDRESS

__________________________________________ __________________________________________ CITY STATE ZIP CITY STATE ZIP

(________)_________________________________ (________)__________________________________ AREA CODE/CELL PHONE NUMBER AREA CODE/CELL PHONE NUMBER

(________)_________________________________ (________)__________________________________

FAX NUMBER SCHOOL FAX NUMBER

___________________________________________ ____________________________________________ E-MAIL ADDRESS (absolutely required) E-MAIL ADDRESS (absolutely required)

Our entire delegation will consist of ____ people ( ____ students + ___ Teacher/Advisors)

Number

_______ Student(s) -- $60.00 $____________

_______ Teacher/Advisor Shared Room $0.00 $ 0.00 (one T/A per 19 students)

_______ Teacher/Advisor Private Room $ 95.00 $____________ (one T/A per 19 students)

_______ Teacher/Advisor with spouse $95.00 $____________

(Double Room)

_______ Late Fee after January 17 (Per Student) $10.00 $____________

_______ Paper Registration Administration Fee (Per Student) $10.00 $____________

Please enclose ONE INCLUSIVE CHECK/PAYMENT for the amount of: $____________

NO REFUNDS after the Registration Deadline -- $10.00 Late Registration Fee PER PERSON

Make Checks Payable to and Mail to:

THE JUNIOR STATE OF AMERICA

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ARIZONA CENTENNIAL CONVENTION -- HOTEL ROOMING LIST

(To be used as a guide before submitting online)

HIGH SCHOOL ______________________________________________________

* Please print VERY clearly -- your nametags will be made from this list. * Students from other schools should not be listed on your form.

* 4 students per room will share 2 double beds--fill each room to the extent possible. * Students of the same sex who are staying an extra night should be roomed together.

* Make sure your teacher approves this list, including his/her room arrangements, by signing his/her name at the bottom. * Make a copy of this list before you send us the original.

ROOM #1 -- Females

ROOM #1 – Males

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ROOM #2 -- Females

ROOM #2 – Males

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ROOM #3 -- Females

ROOM #3 – Males

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TEACHER/ADVISORS (first and last name)

Please print clearly -- your name tag will be made from this list.

Room Type

Private or Shared

Room Price

Roommate Request or Spouse (List Name)

Mrs./Ms./Mr.

Mrs./Ms./Mr.

Mrs./Ms./Mr.

Teacher Advisor Approval:

I have reviewed our school's Registration Form and Hotel Rooming List. It is accurate, and I approve of the students attending.

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ADDITIONAL DELEGATES Hotel Rooming List (Continued from previous page)

Please TYPE or PRINT CLEARLY

HIGH SCHOOL ________________________________________ TODAY'S DATE _________________

Consider your rooming list as your REVISED list; include all delegates who will attend for your school,

including the new additional students and replacement students.

You may need to make copies of this form first in order to include all of your delegates.

Teacher/Advisor Approval: I have reviewed this list. It is accurate, and I approve of the students attending:

___________________________________________________

Teacher/Advisor Signature

ROOM #4 -- Females

ROOM #4 – Males

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ROOM #5 -- Females

ROOM #5 -- Males

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4

ROOM #6 -- Females

ROOM #6 -- Males

1

1

2

2

3

3

4

4

ROOM #7 -- Females

ROOM #7 -- Males

1

1

2

2

3

3

Figure

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