PSMLA / Messiah College Workshop Registration
Registration Deadline: March 19, 2018
Event Date: Saturday, March 24, 2018
Registration will not be complete until your payment is received.
First Name for Badge (if different)
Communication will be via the address you provide. Be sure it is an address that you check frequently.
School / College Affiliation
This refers to where you work(ed). For student teachers, this is your teacher preparation program.
Full-Time Student / Student Teacher
Act 48 PPID Number
Note: Act 48 hours are for PSMLA members only. This is a 7-digit number. Be sure that your first and last name on this registration form are identical to your PDE record. After the workshop, you will receive an email to the email address on this form with instructions on completing a Student Impact Statement so that your hours can be uploaded to PDE. If you are not a PSMLA member but would like to join in order to receive Act 48 hours, please make that selection below to join as a member.
If you are unsure of your membership status, email PSMLA Secretary Phyllis Rzodkiewicz at
. Non-members may join PSMLA to receive member benefits (including Act 48 hours) and the reduced workshop price.
PSMLA Member - $25
AATF Susquehanna Valley Member - $25
PSMLA & AATF Susquehanna Valley Member - $15
Non-Member + PSMLA Membership through June 2019 ($10 discount) - $75
Non-Member - $35
Full-Time Student - $15 (register with your university email address)
Instructions for payment will appear on the next screen.
Credit or debit card (online)
Check (by mail)
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