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* 1. Last Name

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* 2. First Name

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* 3. District Affiliation

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* 4. School Affiliation

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* 5. Work phone (000-000-0000)

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* 6. By providing your preferred email, we will add you to communication email regarding upcoming 2020-2021 mentor teacher/content leader training information. Also, visit our website: latechcrrc.org. 

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* 7. Optional: If you are a district leader, please list anticipated participants. Also, note if you are interested in direct billing options for coursework.

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