SAFETY IN THE ART ROOM
Event Date: Thursday, October 5, 2017
Event Time: 4:30 pm to 6:30 pm
Event Cost: FREE for current NYSATA members; $5 per person for non-members
 
–– Pre-register by 10/2/17.  Any payment due at the door (cash or check).

If you have any questions, contact nysataregion10@gmail.com.
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Full Name *
Are you a current NYSATA member? *
Workshop/event title *
Required
I understand the payment due will be *
Date of Birth *
(for CTLE verification) – Remember to change default year, if one appears
MM
/
DD
/
YYYY
Last 4 digits of your Social Security Number *
(for CTLE verification)
Your Email Address *
Your Phone Number *
The phone number above is a: *
What grade(s) do you teach? (check all that apply)
Only leave blank if you are currently a student- or retired-member.
School District
Only leave blank if you are currently a student- or retired-member.
Superintendent Name
Only leave blank if you are currently a student- or retired-member.
Art Department Chairperson/Director Name
School Building
Only leave blank if you are currently a student- or retired-member.
Principal Name
Only leave blank if you are currently a student- or retired-member.
School Address
Only leave blank if you are currently a student- or retired-member.
I understand my full payment (if a non-NYSATA member) will be due at the door on the day of this event, and that I will receive a confirmation email upon submitting this form. *
Payment options: Cash or Check at the door.
Required
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