Early Learning Conference 2019 Registration

Name *

I select to attend:

Conference Track 1: On Day 1, I will attend keynote sessions and activities. On Day 2, I will attend keynote sessions and activities.
Conference Track 2: On Day 1, I will attend keynote sessions and activities. On Day 2, I will attend the early childhood EE certification course to become a certified educator in 3 early childhood EE programs (Getting Little Feet Wet, Growing up WILD and PLT's early experiences in environmental education). With this track, you will receive early childhood modules of Project WET, Project WILD and PLT. This special certification program is a 6 hour course on conference day 2 and has an additional associated fee of $65.

School or Educational Affiliation *

Contact Email Address *

Contact Phone Number *

Grades you most regularly work with (select all that apply): *

Pre-K

K-5

6-8

9-12

Do you require ECE credits for this conference? *

Yes
No

If yes, please complete the DOB and SSN information below:

Date of Birth:

Last four digits of your social security number:

Please list any dietary restrictions in detail:

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