Participants: (Register 3 or more and receive a discount)

1 Member @ $125
2 Members @$250
3 Members @ $300
4 Members @ 400

1 NON-Member @ $225
2 NON-Members @$450
3 NON-Members @ $600
4 NON-Members @ $800

First Name:*

Last Name:*

School Building:*

School District:*

Billing Address:*

City:*

State:*

Zipcode:*

Phone Number:

E-mail Address:*

Total Cost: $

P.O. Number:*
(all registrations must be submitted with a pre-approved purchase order number to be accepted.)

     - - - - - - - - - - - - - - OPTIONAL INFORMATION - - - - - - - - - - - - - -

If registering two or more, please add the additional participants names below.

Name of Participant 2:

Email:

Name of Participant 3:

Email:

Name of Participant 4:

Email:

Cancellation Policy:
Due to a limited number of participants that can attend this workshop, cancellations will not be refunded two weeks prior to the date of the workshop.
Your district may send another staff member in your place, if you are unable to attend after the cancellation date.
Please submit any substitutions to Julie Knernschield at jknernschield@smcaa.org or by calling 573-635-2299