Registration Form

Please complete and submit this form in order to get pre-registered for training sessions. A confirmation letter will be sent to you upon recieving your registration.

E-mail Address
First Name
Last Name
Title of Activity
Date of Activity (mm/dd/yyyy)
School District
School Name
School Phone
Home Phone
Home Address
City
State
Zip Code

IMPORTANT! If you must cancel your registration, it must be done 48 hours in advance.

Note: Participants may apply for Continuing Education Credits (CEU's) for approved training sessions. CEU's are provided through Delta State University's Division of Continuing Education and require a $15 application fee. Participants are responsible for this charge on the last day of the workshop. Checks should be made payable to Delta State University.

This webpage maintained by Rogan Jackson