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Administrator Academy Registration Form
ROE Contact Person: Bill Lamkey/Angie Durall

Location: Sangamon-Menard ROE Staff Development Center; Activity Room B (2ndFloor); 2201 Toronto Road (Exit #90 off I-55), Springfield
Email address *
Which Workshop Are You Registering for? *
Last Name, First Name: *
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Position: *
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IEIN #: *
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Home Address: *
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Home City and Zip Code: *
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Home Phone #: *
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School District Name and #: *
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School Building Name: *
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School Address: *
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School County: *
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School Phone #: *
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A copy of your responses will be emailed to the address you provided.
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