First Name:*

Last Name:*

School Building:*

School District:*

Billing Address:*

City:*

State:*

Zipcode:*

Phone Number:

E-mail Address:*

Member Status: Member    Non-Member

Total Cost: $

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

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 Riley at jriley@smcaa.org or by calling 573-635-2299