Empowering English Learner Families

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

cost Please Email

Email *

Phone

School and County *

I will pay the registration cost of $50 by *

• Purchase order
• Credit Card

Stripe Credit Card

Card

Name on Card

Please read and check the boxes to submission *

• I agree to notify MSESC 24 hours prior to the training if I am unable to attend.
• I understand that failure to notify MSESC 24 hours prior to missing the training will result in being charged the full amount.

Submit