Conference Request Form
In order to justify the costs of conferences and to help professionally develop our membership, it is required that you write an article for the Val Verde Educator (Formerly known as the Focus) or do a Mini-PD open to the membership. The article needs to be written up within two weeks or the PD scheduled within the same time frame. Thank you for helping to develop our profession.
Are you willing to write an article for the Val Verde Educator?
Are you willing to present a Mini-PD after school to your colleagues at the VVTA offices?
First Name
Your answer
Last Name
Your answer
Home Email
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Home Address
Street Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Emergency Contact
First Name
Your answer
Last Name
Your answer
Emergency Contact Phone
Your answer
Attendee Professional Information
How many years have you been in Education?
Your answer
Current position in the Association
Check all that apply.
Required
Teaching Assignment
School Site
What Grade do you teach?
Check all that apply
Required
Curricular Area
Your answer
Conference Information
Name of Conference
Required
Have you attended this conference before?
How many conferences have you attended through VVTA / CTA?
Date of Conference
MM
/
DD
/
YYYY
Last Day to Register
MM
/
DD
/
YYYY
Location of Conference
Your answer
Cost of Conference
Necessary only if it is not a CTA conference.
Your answer
Do you need a hotel room?
Do you require a private room?
VVTA pays for two people in a room, if you would like a private room, you must pay half of the total room cost.
Hotel Room Rate (per night)
Necessary only if it is not a CTA conference
Your answer
Do you have a roomate preference? Who?
Your answer
Courses/Sessions wanted
Please note session and course if applicable, if not put NA
Your answer
How will you use what you have learned at this conference to contribute to our Association and District?
Your answer
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