2019-2020 Critical Feedback Group Registration Form
Session Dates*:
9/25/19
1/8/20
4/8/20

*The other 4 dates are determined by coaches at different times and locations*

Pricing:
Full price: $275
Price With Early Bird Discount: $225
Group Discount (groups of 3 or more): $ 175 per person
Price as First year PRN Graduate: $125
Price as Current PRN Mentor: $125
Principal/school leader & teacher leader buddy pair: $350


Early Bird Discount Deadline: September 1st
Application Deadline: September 24th

PayPal Link:
paypal.me/cleesummit

Email address *
Participant 1
First Name: *
Your answer
Last Name: *
Your answer
Telephone Number: *
Your answer
School District/Name: *
Your answer
School/District Contact Title/Role: *
Your answer
School/District Contact Email: *
Your answer
Select from the options below *
Are registering as an individual or team? *
How are you going to pay? *
Billing Address (school/district business office or individual billing address): *
Your answer
Billing Email (if bill can be sent via email):
Your answer
Notes or Special Requests:
Your answer
Important: If copy registration form is needed for PO request, please PRINT before clicking submit button below.
Mailing address for payments: Center for Leadership and Educational Equity, PO Box 9259, Providence, RI 02940
Please Note: for school/district teams, include all participant contact information in the space provided below. Participant one information should be entered above.
Participant 2 Information
Name:
Your answer
Email:
Your answer
Title/Role/School:
Your answer
Participant 3 Information
Name:
Your answer
Email:
Your answer
Title/Role/School:
Your answer
Participant 4 Information
Name:
Your answer
Email:
Your answer
Title/Role/School:
Your answer
Participant 5 Information
Name:
Your answer
Email:
Your answer
Title/Role/School:
Your answer
Participant 6 Information
Name:
Your answer
Email:
Your answer
Title/Role/School:
Your answer
Important: If a copy of the registration form is needed for PO request, please PRINT before clicking submit button below.
Mailing address for payments: Center for Leadership and Educational Equity, PO Box 9259, Providence, RI 02940
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Center for Leadership and Educational Equity. Report Abuse - Terms of Service