Register for CEU

"*" indicates required fields

Name*

First Middle Last

Hidden

Event Date

Address*

Street Address Address Line 2 City State ZIP Code

Social Security Number

Required for CEUs. Can be provided by phone.

Date of Birth

Required for CEUs. Can be provided by phone.

School District Employed*

School Where You Teach

Email*

Phone*

School or personal phone.

Today's Date

Signature

Typing your name in this box represents your signature.

Event Date*

20% discount ends July 1, 2022. Registration is $420 after July 1.

Total

How are you paying?

Credit Card

Paypal

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

P.O. Number

Find Us At