Registration Form - Media Teachers' Lab 11.10.2014 URI Providence Campus

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FIrst Name *

Last name *

Email *

Phone *

Afiliations *

Role *

K-12 Teacher

Behavior Specialist

Library Media Specialist

Technology Coordinator

Student

Administrator

Instructor, Lecturer, Professor

Required

Are any accommodations regarding disability needed?

Yes - Please contact Jeannine Chartier programs@vsartsri.org

I give my permission to the Media Teachers' Lab organizers to use any artifacts and content that I produce during the workshop for program evaluation, as well as research, educational, and promotional purposes. I give my permission to the Media Teachers' Lab organizers to use all images, sound, and videography of me recorded at the workshop for research, educational, and promotional purposes. I understand and agree to allow the Media Teachers' Lab organizers to use all photography, videography, and audio recordings of me in any present or future media, including television and Internet broadcast.

I Agree

Interested to receive newsletters and information from:

RISCA

VSA Arts RI

Media Education Lab

I would like to recieve a parking validation for the Convention Center

1 Parking Validation for the Convention Center

I would like to recieve a PD certificate from RISCA for 3 hour workshop

Certificate

Submit

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