Your Information

Registration Options

Workshop Registration Fee ($150.00)
Includes meals, sleeping accommodations & field trip transportation. In addition you will receive professional development hours.
Reg Fee ($150) + Grad Credit ($250) ($400.00)
I would like to earn grad credit through Lindenwood University and pay the additional $250 grad credit fee now along with the workshop registration fee.
Reg Fee ($150) + Grad Credit (Pay Later) ($150.00)
I would like to earn grad credit through Lindenwood University and pay the $250 grad credit fee on or before the first day of the workshop.

*Please Note: The $150 registration fee is non-refundable.

Name

Address

You may share my email address with other participants.

Primary Phone Number

T-Shirt Size

Name of School

City or town where school is located

Grade / Subject

Your Illinois Educator Identification Number (enter N/A if you do not want credit)

In Case of Emergency Call

Emergency Phone Number

Name of teacher you would like to share a room with

Check here if you live nearby and wish to go home each night.

Any special dietary needs?

How did you hear about the workshop?

Billing Information

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Name

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Address

Phone Number

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