TeamPlayGround Registration
Please complete and mail to:
Notre Dame de Namur University
School of Education & Leadership
Joanne Rossi Ed.D.
1500 Ralston Avenue
Belmont, CA 94002
Contact Information
*
First Name
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Last Name
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Street Address
Address Line 2
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City
*
State/Province/Region
*
Zip/Postal Code
*
Country
*
Email Address
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Phone Number
Professional Information
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I am a
School Administrator
Teacher
Student
Other
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School or School District
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Which TeamPlayGround training would you like to attend?
June 23 - 26 $395/$250 student
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Do you wish to receive CEUs for the training?
(No additional charge)
Yes
No
Payment Information
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Name on Card
*
Credit Card Type
Visa
MasterCard
American Express
Discover
*
Credit Card Number
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CSC Code
*
Expiration Date (mm/yy)
Bill To Information
Please provide the following information if it is different from the contact information above.
First Name
Last Name
Street Address
Address Line 2
City
State/Province/Region
Zip/Postal Code
Phone Number
Country
*
Indicates Response Required