PSMLA / Messiah College Workshop Registration
Registration Deadline: April 17, 2017
Event Date: Saturday, April 22, 2017

Registration will not be complete until your payment is received.

First Name
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Last Name
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Email Address
Communication will be via the address you provide. Be sure it is an address that you check frequently.
Your answer
Phone Number
xxx-xxx-xxxx
Your answer
School / College Affiliation
This refers to where you work(ed). For students, this is your teacher preparation program.
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Level(s) Taught
Required
Language(s) Taught
Required
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.
Your answer
Registration Level
If you are unsure of your membership status, email PSMLA Secretary Phyllis Rzodkiewicz at secretary@psmla.org. Non-members may join PSMLA to receive 2017 member benefits (including Act 48 hours) and the reduced workshop price.
Payment
Instructions for payment will appear on the next screen.
Notes (optional)
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