Virtual EL Training Registration-February 24

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

Email *

Phone *

School/County

Subject/Grade Level

I Will Pay

• Purchase Order
• Credit Card

Stripe Credit Card

Card

Name on Card

Registration Cost

Price: $50.00

Please Select the Following: *

• I agree that I will 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.

Email

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