District 12 Fall Inservice Registration
First Name *
Your answer
Last Name *
Your answer
PMEA Membership Status *
Will you require a receipt?
If you indicate "Yes", a receipt will be provided on the day of the inservice.
PMEA Membership Number
Your answer
PDE Professional Personnel ID Number
(Necessary for Act 48 credit)
Your answer
School District Name
Your answer
School District Street
(Example: 123 Main Street)
Your answer
School District City, State and Zip
(Example: Anytown, PA 19999)
Your answer
Home Address Street
(Example: 123 Main Street)
Your answer
Home City, State and Zip
(Example: Anytown, PA 19999)
Your answer
Home Phone
Your answer
Email Address
Your answer
Choral Packet
String Instrument
If you are participating in a STRING Reading Session, please BRING A MUSIC STAND and indicate your instrument.
Your answer
Band Instrument
If you are participating in a BAND Reading Session, please BRING A MUSIC STAND and indicate your instrument.
Your answer
Session 1 Choice *
PLEASE NOTE: "Developing Independent Musickers: Activities for Elementary General Music" has been moved to Session 3.
Session 1 Alternate *
PLEASE NOTE: "Developing Independent Musickers: Activities for Elementary General Music" has been moved to Session 3.
Session 2 Choice *
Session 2 Alternate *
Session 3 Choice *
Session 3 Alternate *
Session 4 Choice *
Session 4 Alternate *
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