2021 Virtual Academic Conference Registration Form

2021 Virtual Academic Conference Registration

Please fill out the form below to register for the Virtual Academic Conference, which will be held March 13th (9:00am-12:00pm CST). All registered participants will be entered to win a copy of the keynote’s book (Dr. James Lang, Distracted: Why Students Can’t Focus & What You Can Do About It). If you win, the address you enter below will be used to ship your book. Additionally, your email will be used to send information about the Virtual Academic Conference and FCI communication. We look forward to seeing you there!
Full Name *

First Name Last Name
Park Email Address *
Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Please describe your role at Park University (select all that apply):

Remote Parkville Campus Part-time Full-time
In which modes do you regularly teach (select all that apply)?

Face-to-face Blended Pirate Patch Online
Should be Empty: