Teacher Workshop Online Registration

Teacher Workshop Online Registration Form



Registration FormConfirmationOnline Payment

Teacher's Information for Registration and Online Payment

Entries with * are required.

First Name: *
Last Name: *
Home Phone: *
Email Address: *
IEIN (Illinois Educator Identification Number):
Address1: *
Address2:
City: *
State: *
Zip Code: *

Teacher's School Information

Currently teaching: * If yes, fill in the rest of this section. If no, skip it.

School Name *
Your School Email: *
Your School Phone* *
Grade Levels Currently Teaching: *
Address1 *
Address2:
School City: *
School State*
School Zip: *
School District:
 If you do not see your school district in the pull-down, enter it below.

Other School District:

Workshop Information

Enter the workshops you plan to take, one workshop per line.

Teacher WorkshopFee
Total:

Confirm Registration Information

Please review all your information and set Registration Information Confirmed to "Yes" to indicate you are ready to submit the registration. Then click Submit Registration
Registration Information Confirmed:*
Leave blank:
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