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 *

Tuition

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

Individual form a Non-MACS Member School ($95.00 per attendee)

After clicking submit, you will be directed to the PayPal page where your payment of either $75.00 or $95.00 can be paid online.

If you choose not to use PayPal, notify Maggie Sullivan (maggie@mncharterschools.org) and send a check to:

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