Engaging Students With Poverty in Mind

May 16, 2016 - July 29, 2016

District Number

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District Name

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Building Name

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Last Name of Attendee

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First Name of Attendee

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Work Phone

ex. xxx-xxx-xxxx

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Cell Phone

ex: xxx-xxx-xxxx

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E-Mail Address

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Who will be paying the registration fee?

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Billing Address (for Self Pay) (Please Enter Address, City, State, Zip Code)

Enter "District Office" or "Free" if not Self Pay

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