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PSMLA / Chestnut Hill College World Language Teacher Immersion Day Registration
For teachers of French, German, Spanish, and Chinese

Registration Deadline: March 2, 2017
Event Date: Saturday, March 11, 2017

Registration will not be complete until your payment is received.

First Name
Your answer
Last Name
Your answer
Home Street Address
Your answer
City, State, ZIP Code
Your answer
Home Email Address
Your answer
Phone Number
xxx-xxx-xxxx
Your answer
School / College Affiliation
This refers to where you work(ed). For student teachers, your teacher preparation program.
Your answer
School / College Email
Your answer
Language(s) Taught
Required
Act 48 PPID Number
Note: Act 48 hours are for PSMLA members only. This is a 7-digit number. Be sure that your first and last name on this registration form are identical to your PDE record. After the workshop, you will receive an email to the email address on this form with instructions on completing a Student Impact Statement so that your hours can be uploaded to PDE. If you are not a PSMLA member but would like to join in order to receive Act 48 hours, please join at psmla.org or see membership instructions below.
Your answer
Registration Level
If you are unsure of your membership status, email PSMLA Secretary Phyllis Rzodkiewicz at secretary@psmla.org. You may also join PSMLA today to take advantage of the reduced member rate, receive Act 48 hours, and obtain all member benefits. Cost is $50 for one year membership and $80 for two year…Student membership is $30 for one year and $45 for two year….Please include it in your total when sending the check for this day. Mailing address for your check, payable to PSMLA, will appear on the next screen. You may also pay via credit card.
Payment
Notes (optional)
Your answer
Submit
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