EmailMe Form - Mental Health Online Workshop Registration

Name *

First Last

Home Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email *

Preferred Phone #

### - ### - ####

School/Organization Affiliation *

Class Choice *

MACS Mental Health Online Workshop - Session 2 - April 18, 2016 to May 6, 2016

Tuition *

Individual from a MACS Member School/Individual Associate Member ($75.00 per attendee)

Individual from a Non-MACS Member School ($97.00 per attendee)

Please indicate the amount you will be paying for this course. After completing this form, your payment of either $75.00 or $97.00 can be paid online via PayPal, on the MACS Mental Health page.

**Note: Registration is not complete until MACS receives payment.

If you choose not to use PayPal, notify Adan Gutierrez (adan@mncharterschools.org) and send a check to:

Minnesota Association of Charter Schools
161 St. Anthony Avenue
Suite 1000
St. Paul, MN 55103