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

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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: 1st Choice: 2nd Choice:

Games: 1st Choice:

Student Notebook:

Teacher Recharge:

Combination Retreats:

Poster & Notebook

Notebook & Games

Games & Poster

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