Eastern Michigan University

Educator Preparation: A Call to Action in Michigan

November 1, 2013

Eastern Michigan University Student Center

Registration Information

  • Questions about the conference: Regina George, rgeorge@emich.edu
  • Questions about your registration: Karen Metz, kmetz@emich.edu
  • Your conference registration will be confirmed by email.

Participant Information:

First Name Last Name

Email

Home Address

City   State   Zip

Employer

Job Title

Employer Address

City   State   Zip

Phone Cell Work Phone

How did you learn about the conference? Website Colleague  Email   Other
If Other, please specify:

Please register me for: [select no more than two (2)]

Leadership (administrators, teachers as leaders)

Effectiveness (PK-12 and institutions of higher education, PK-12 and IHE educators)

Engagement (social justice, equity, family,community)

21st Century Classrooms (inclusion, technology skills & literacy, global competence, clinical practice)

Conference fee (select one):

Student fee: $10

Professional fee: $25

EMU Faculty/Staff: no charge

Disclaimer:

I understand that this event may be filmed and photographed.

Method of payment:

**If you are EMU Faculty/Staff, you do not need to fill out the payment information fields. Please scroll to the bottom of the form and click Submit.**

If paying by credit card, please enter your payment information below.

Check payable to Eastern Michigan University, mailed to Eastern Michigan University, Attn: Educator Preparation, 103 Boone Hall, Ypsilanti, MI 48197


Credit Card Information:

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Credit Card: MasterCard VISA  Discover  AMEX 

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Three-digit Security Code (back of card) or 4 digit code on front of AMEX: