Today's Date
Registration
Your Name
Your Organization
Your Address for the Participant List
City
State or Province
Zip or Postal Code
Country
Mailing address (if different from above)
City
State or Province
Zip or Postal Code
Daytime Phone Number
Night/Weekend Phone Number
E-mail address (preferably non-school)
Second e-mail address
How are you paying?
If by purchase order and check, what is the purchase order number?
Are you attending certified trainer sessions? ($50 fee)
Are you staying on campus?
If off campus, do you want us to provide you with a parking permit when you register for the Institute? (1 per vehicle if you are with a group)
Tuesday afternoon session preference?
If you are attending T-1, Strategies for Teaching Boys and Girls, what age level are you interested in?
Wednesday morning session preference?
Do you have a medical condition we should know about?
Comments?
Image Verification
captcha
Please enter the text from the image:
[Refresh Image] [What's This?]