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1. Register for CSD's Distance Learning Academy.

You are registering for CSD's Distance Learning Academy for the 2010-2011 school year. Please take a moment to answer the following questions. You will be asked for a P.O. number or credit card number in order to complete your registration.

Cost for the academy is $299 per person which includes:
(discount for New Links Members, $249) Contact Rebecca Morrison for questions at 314.692.1274 or rmorrison@csd.org

-virtual field trip/videoconference gift certificate, valued at $50
-access to New Links Program Coordinator during the academy
-two eLearning platforms (online portal for classes)
-15 hours of face to face professional development
-online support for learning & collaborating
-attendance at one day of the Midwest Education Technology Conference (METC)
-light snack each day of the training

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* 1. First Name, Last name

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* 2. Nick Name for Name Tag

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* 3. Home adress including city, zip, and home phone

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* 4. District and School Name, School Address including City and Zip Code

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* 5. Telephone numbers: Work #, Cell #, Fax #

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* 6. What is your position or title?

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* 7. What is your current email address:

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* 8. Will you be paying by P.O. or credit card?

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* 9. What type of credit card will you be using?

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* 10. What is your P.O. number or credit card number? If you don't have a PO number at time of registration, insert person responsible for payment.

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* 11. If you entered a credit card number, what is its expiration date?

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* 12. Whose name is printed on the credit card? Please type in the full name on the card.

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