PSMLA / Dickinson College Workshop Registration
Registration Deadline: October 26, 2018
Event Date: Saturday, November 3, 2018
First Name *
Your answer
First Name for Badge (if different)
Your answer
Last Name *
Your answer
Email Address *
Communication will be via the address you provide. Be sure it is an address that you check frequently.
Your answer
Academic Affiliation *
This refers to where you work(ed). For student teachers, this is your teacher preparation program.
Your answer
Level(s) Taught *
Language of Gallery Tour *
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 Non-members may join PSMLA to receive member benefits (including Act 48 hours). Contact AATF Chapter President Heather Dravk at with questions related to AATF membership.
Please note any special needs.
Disability accommodations, private location for breast pumping, dietary restrictions.
Your answer
Guest *
After clicking "Next," be sure to scroll back up and click "Submit" when all questions are answered to complete registration.
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