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 : 1st Choice: N/A June 9-11 June 23-25 2nd Choice: N/A June 9-11 June 23-25

Poster Making ESL: 1st Choice: N/A June 13-15 July 10-12 2nd Choice: N/A June 13-15 July 10-12

Games: 1st Choice: N/A July 14-16 July 21-23 2nd Choice: N/A July 14-16 July 21-23

Notebook: N/A July 27-29

New Teacher : N/A July 6-8 (Only one retreat available, if interested in another date please use comment box below)

Comments(if applicable):

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