Conference Registration

School Information

School Name *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Point of Contact

Name *

Email Address *

Phone *

Conference Attendee(s)

Attendee Name *

Attendee Email Address *

Attendee Phone *

Number of Years Teaching / Admin *

Subject Taught *

T-shirt Size *

Dietary RestrictionsPlease list any dietary restrictions or allergies:

Pre and Post Conference SessionsPlease check all pre and post conference sessions you plan to attendJMU Course - Classroom Management (EXED 440)CHI Cosmetology Lab Workshop [ Pre-Conference 7/20 ]Automotive Service Excellence ASEOSHA Scaffolding Awareness CourseMilady Master Educator [ Pre-Conference 7/21 8AM ]JMU Course - Curriculum Development (EXED 303) [ Post Conference 7/23-28

Attendee Total

$

Attendee Line

{name-2}

{email-2}

{phone-2}

{number-1}

{select-2}

{checkbox-1}

{select-1}

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Additional Invoice Recipients

Email Address

Registration Total

$

ATTENDEE NAMES

{name-2-*}

Billing Data

{text-1}

{address-1-street_address}

{address-1-city}, {address-1-state} {address-1-zip}

Payment

Payment Method

Credit / Debit Card *