Full Name
*
First Name
Last Name
Registrant Classification
*
Professional registrant
Team - Up to 10
Student
Higher Education
School/District Administrator
Educational Consultant
Community Partner
Vendor
Other
Team members
*
Team member 1
First Name
Last Name
Team member 2
First Name
Last Name
Team member 3
First Name
Last Name
Team member 4
First Name
Last Name
Team member 5
First Name
Last Name
Team member 6
First Name
Last Name
Team member 7
First Name
Last Name
Team member 8
First Name
Last Name
Team member 9
First Name
Last Name
Team member 10
First Name
Last Name
Team payment method
Check
Organization/Institution
Focus Area
Elementary
Secondary
Postsecondary
District
Other
Will you attend both PD days?
Yes, I will attend both days.
No, I will only attend session on June 28th.
No, I will only attend sessions on June 29th.
Session Interests
Instructional Strategies
Student Engagement
Leadership Development
Equity in Education
Technology Integration
Professional Growth
Curriculum and Assessment
Coaching and Mentoring
Exceptional Student Services
Wellness and Self-Care
College and Career Readiness
E-mail
*
example@example.com
Type of E-mail
Business E-mail
Personal E-mail
Phone Number
*
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Total fee
Number of team members
*
Conference Registration
June 29: Sessions 1:00 - 5:00 pm Reception 5:30 - 7:30 pm June 30: Sessions 9:00 am - 3:00 pm
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Type of E-mail
Business E-mail
Personal E-mail
Phone Number
*
Format: (000) 000-0000.
Organization/Institution
Focus Area
Elementary
Secondary
Postsecondary
District
Other
Will you attend both PD days?
Yes, I will attend both days.
No, I will only attend session on June 28th.
No, I will only attend sessions on June 29th.
Session Interests
Instructional Strategies
Student Engagement
Leadership Development
Equity in Education
Technology Integration
Professional Growth
Curriculum and Assessment
Coaching and Mentoring
Exceptional Student Services
Wellness and Self-Care
College and Career Readiness
Registrant Classification
*
Professional registrant
Student
Higher Education
School/District Administrator
Educational Consultant
Community Partner
Vendor
Team - Up to 10
Other
Team Registration
Number of team members
Team member 1
*
Team member 2
*
Team member 3
*
Team member 4
*
Team member 5
*
Team member 6
*
Team member 7
*
Team member 8
*
Team member 9
*
Team member 10
*
Team Total (USD)
Team payment method
Pay by Check
Payment Section
Coupon Code
Registration Pricing
*
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Professional Registrant
$50.00
$
50.00
Quantity
1
2
3
4
5
6
7
8
9
10
Student Registrant
$25.00
$
25.00
Quantity
1
2
3
4
5
6
7
8
9
10
Team - Up to 10
$50.00
$
50.00
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Methods
Credit Card
Apple Pay
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Google Pay
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