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2020 MBEA State Conference Registration - Friday, September 25, 2020
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* Indicates required question
Email
*
Your email
Title (Mr., Mrs., Ms., Dr., etc.)
Your answer
First Name
*
Your answer
Last Name
*
Your answer
Name Desired on Badge
Your answer
School/Place of Employment (or attendance, if student)
*
Your answer
Preferred Mailing Address
*
Your answer
City/State/Zip
*
Your answer
School Phone Number
*
Your answer
Cell Phone Number
*
Your answer
Professional E-mail Address
*
Your answer
NBEA Membership # (if applicable)
Your answer
Check one:
*
Secondary/Middle
Community/Jr. College
University
Student
Retiree
Business/Industry
Check one:
*
Career/Technical Business
Academic Business
ICT/STEM/Tech Foundations
SAD/Graphic Design
Administrator
Teacher Education
Other:
Specific Subject Area/Position:
*
Your answer
Are you interested in earning CEUs (for an additional fee)?
*
Yes
No
Maybe
CEUs ONLY -- What is your teaching license number?
Your answer
Please indicate permission to use your photo in MBEA publications (print and digital):
*
Yes
No
Required
Conference Registration/Membership Fee
*
Choose
Professional Registration/Membership Fee - $80
Undergraduate Student Registration/Membership Fee - $65
LATE Professional Registration/Membership Fee - $100 (after August 28)
LATE Undergraduate Student Registration/Membership Fee - $75 (after August 28)
Method of Payment
*
Personal or School/Business Check sent via Mail
Electronic Payment via PayPal (pay total via
https://www.paypal.me/MSBusEd
)
Purchase Order from School/District (sent by e-mail or Mail)
Other:
Please list Purchase Order number from School or include any other details regarding payment or additional contact information, if needed.
Your answer
By submitting this form you are responsible for the registration fee. Payment is non-refundable.
*
Yes, I agree to pay the registration fee stated above and understand the payment is non-refundable.
Required
(Optional) Recruited by:
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