Registration for IDM Institute in Burlington Wednesday June 26 -Thursday June 27, 2019
* Required
Your First Name
*
Your answer
Your Last Name
*
Your answer
Your Professional Title
*
Your answer
Your Organization or School District
*
Burlington Public Schools
Other:
Required
Your School (if applicable)
Your answer
Your Preferred Email Address
*
Your answer
Phone (optional)
*
Your answer
Professional Role
*
Teacher
Curriculum Specialist, Coach or Leader
Administrator
Museum/Cultural Institution Educator
Media/Library Specialist
Other:
Grade Level(s) of students with whom you work
*
K-2
3-5
6-8
9-12
Adults
N/A
Other:
Required
Number of seats you would like to reserve
*
1
2
3
4
5
6
7
8
Other:
If you selected two or more seats, please list attendees, if known. T.B.D. is acceptable.
Your answer
How will you be paying the registration fee?
*
The options below are the only payment options. Unfortunately we cannot accept credit cards, PayPal, etc. Upon registration we will generate and email you an invoice. Checks must be received by June 15, so please submit POs to your district for payment as soon as possible once you have the invoice. Thank you for your cooperation.
Personal check
Purchase Order
I work for Burlington Public Schools--please include in in the district group.
Please calculate and enter the amount owed.
Cost: $295 per person; $1100 per team of four people
Your answer
If paying by PO, please provide the mailing address of your district or organization's Accounts Payable office.
We will send you an invoice shortly following submission of this form, will which tell you or your business office where to mail the check (123 Cambridge St. Burlington, MA 01803; or email it to
bercury@bpsk12.org
)
Your answer
If paying by personal check, please provide your full mailing address
Your answer
A lunch will be provided both days. Please inform us of any special dietary needs or requests.
Please note: We will try to accommodate needs but cannot guarantee absence of or no cross-contamination from allergens.
Your answer
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