Charter Development 101 - Registration - January 12, 2013 Survey

1. Charter Development 101 - Registration

Thank you for registering for Charter Development 101 offered through The Georgia Charter Schools Association. This workshop is facilitated by GCSA staff.

Space is limited to 25 participants for this workshop. Payment for training is due in full prior to facilitation.

Several training dates and locations are available in 2013. Please select the location and date below.

Thank you again for your interest.

1. Please select the training date from the following list:

Please select the training date from the following list:

2. Please complete your contact information.

Please complete your contact information. Name:
School:
Address:
Address 2:
City/Town:
State:
ZIP:
Email Address:
Phone Number:

3. I am a GCSA member.

I am a GCSA member. Yes

Unsure

4. Please select the role(s) that you currently serve.

Please select the role(s) that you currently serve. Petitioner/Founder

Leader/Principal/Director

Leadership Team Member

Regular Education Teacher

Special Education Teacher

Gifted Education Teacher

ESOL Teacher

Office Manager

Board Member

Other (please specify)

5. Professional development course(s) for which you are registering:

Professional development course(s) for which you are registering: Charter Development 101

6. Please describe how you will be paying for Charter Development 101. The cost for this workshop is $75.00 per person. Payment must be received prior to the workshop date. Please note that if you are paying by check, your payment will need to be received prior to 1/12/2013, in order to reserve space for the workshop.

Please describe how you will be paying for Charter Development 101. The cost for this workshop is $75.00 per person. Payment must be received prior to the workshop date. Please note that if you are paying by check, your payment will need to be received prior to 1/12/2013, in order to reserve space for the workshop. Bill me

Credit card

7. If charging to a credit card, please provide the credit card information below:

If charging to a credit card, please provide the credit card information below: Type of Card
Name on the Card
Card Number
Expiration Date
CVC Number
Billing Address 1
Billing Address 2
Amount Authorized to Charge

8. If you are bringing additional participants, please list their name(s) AND contact information here:

If you are bringing additional participants, please list their name(s) AND contact information here:

THANK YOU FOR REGISTERING FOR CHARTER DEVELOPMENT 101! You will receive a confirmation email within 24 hours.

Charter Development 101 - Registration - January 12, 2013Exit this survey

1. Charter Development 101 - Registration

Charter Development 101 - Registration - January 12, 2013
Exit this survey