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Registration Form: (Please Fill In Completely)
Name: (Last) (First)
Years Teaching
School District:
School:
School Address: City: Zip Code:
School Phone:
School Email:
Home Address: City: Zip Code:
Home Phone: Cell Phone
Home Email:
Languages (Subjects) Taught: Levels Taught: Years Teaching:
Please select 2 choices from the below retreats in case the one you want is filled:
Poster Making:
Games:
Teacher Recharge:
Student Notebook:
Combination Retreats: Poster & Games
Combination Retreats: Teacher Recharge & Student Notebook
Comments (if applicable):
Payment Options: (please select one)
Please call 713-515-0789 with your credit card information.
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