Community of Practice Online registration Form

Logo: VSA (in red) over Michigan (in black)Community of Practice Workshop

 

Strategies for Engaging Every Student in Learning for Educators, Teaching Artists, University/ College Students and Community Arts Education Providers

August 21-23, 2016
Ralph A. MacMullan Conference Center,
Higgins Lake, Roscommon, MI

Please complete this form and email it to lora@vsami.org or snail mail it to the VSA Michigan office at 111 East Kirby, Detroit, MI 48202.  Respond as soon as possible, as the number of participants is limited.

I would like to register for the workshop.

Name___________________________________________________

Address_________________________________________________

City/State/Zip____________________________________________

Phone_________________________

Email______________________________________

I am an _____ Educator  _____ Teaching Artist

_____ Community Arts Education Provider

_____ University/College Student (Indicate Major) _________________________________

I am an educator and interested in obtaining SCECHs. Yes_____   No_____

_____ I would like to attend the entire workshop.

_____ I would like to attend on Sunday and Monday

_____ I would like to attend on Monday and Tuesday

I would like to room with______________________________

I have the following dietary restrictions:

I require the following accommodations (e.g. large print, Braille, American Sign Language Interpretation):

_____ My registration check in the amount of $100 is enclosed, made payable to VSA Michigan.

_____ Please charge my credit card Number_________________________________ Exp. Date___________ Security Code__________ Billing Zip code___________________

Name as it appears on card
________________________________________________________

Signature___________________________________________________

_____ I would like to be considered for a scholarship to attend this workshop.  Please contact me by
_____ phone or  _____ email to discuss this opportunity.

This program is provided under contact with the John F. Kennedy Center for the Performing ARts (2016)

We look forward to seeing you!!