Register Now:

Participant *ParentEducatorVendorPresenter

Location *County level schoolCharter SchoolOther Agency

Name of County, School, Charter School or Other Agency *

Name *

First

Last

Email *

Phone

Food Allergy-Please list all *

Accessibility-Accommodations, List all *

Emergency Contact-Name/Phone number *

Hotel room needed. I agree to notify Mountain State ESC no later than 48 hours before if I am unable to attend *

• Yes
• No

I plan to eat dinner on June 3 at Stonewall Resort *

• Yes
• No

Mountain State ESC is paying for your hotel room. By registering for this conference, I agree that I will be responsible for any damages or incidentals such as charges to the room, damages , room service, snacks, etc. *

• I agree to these conditions
• I DO NOT agree to these conditions

Educators ONLY: June 4, 2024 is considered an in calendar work day for me *

• Yes
• No
• N/A I am a parent, vendor or presenter

By completing this form, I acknowledge I am not formally enrolled until I receive an email confirmation for admittance to this conference within 2-3 weeks. *

• I agree

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