Registration for CPAM Leadership Seminar. Wednesday, September 25, 2024

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CPAM Leadership Seminar Registration Form for PayPal payments only.

If you are registering for the CPAM Leadership Seminar on September 25, 2024 either in-person, via Zoom, or asynchronously and paying with PayPal please complete this form.

For more information visit https://cpam.org/seminar24

Email *

Check the appropriate box(es). *

$15 -- CPAM member registration fee

$45 -- Nonmember registration fee for awardees (includes membership for 7/1/23 - 6/30/24)

$45 -- Guest Registration fee

Required

Last Name *

First Name *

Nickname / First Name for Badge *

Year of Award *

Award State *

Grade Level *

Elementary

Secondary

Required

Select your appropriate grade band *

K-12

K-4

5-8

9-12

Personal Phone Number Including Area Code *

How will you be attending *

Will attend in Chicago

Will attend via Zoom

Will participate asynchronously

Guest Information. Please make sure you include guest payment.

If you do not have a guest, you can skip the next section.

Guest's last name

Guest's first name

Guest Nickname / First Name for Badge

Guest's grade band

K-4

5-8

9-12

Clear selection

Guest Phone Number Including Area Code

Guest's Email address

How will your guest be attending

Will attend in Chicago

Will attend via Zoom

Will participate asynchronously

Clear selection

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