Register for Executive Leadership Seminar!
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Please
fill out the following information and press the PRINT this PAGE button below.
Then fax or mail to the address below.
Who should attend: Deputy Superintendent, Assistant Superintendent, Chief Academic Officer,
District Leaders in Curriculum, Instruction, and Assessment
Investment: Check series details, below.
Prepayment or a PO number is needed to complete your registration.
Extensive documentation and refreshments are provided.
Presented in partnership with ACSA and, in the Central Valley, CVELI.
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Contact and Billing Information |
| *=Required Field. Please choose one person as your primary contact. |
District/Organization: |
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CDS Number: |
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| This form was completed by: |
Name: |
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Title: |
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Primary contact? |
Check if primary contact |
Choose the ELC Series you wish to attend: |
Note: There is no payment required
here for the Fresno ELC. Your acknowledgement will include
information on payment. |
| Billing Address: |
Purchase Order: |
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Attending |
Participant 1 |
Participant 2 |
Name: |
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Name: |
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Title: |
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If you chose "other",
please describe: |
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If you chose "other",
please describe: |
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Primary contact? |
Check if primary contact |
Primary contact? |
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Site Name: |
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Site Description: |
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Site Description: |
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Participant 3 |
Participant 4 |
Name: |
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Name: |
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Title: |
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Title: |
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If you chose "other", please describe: |
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If you chose "other",
please describe: |
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Primary contact? |
Check if primary contact |
Primary contact? |
Check if primary contact |
Site Name: |
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Site Name: |
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Site Description: |
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Site Description: |
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Phone: |
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Phone: |
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Participant 5 |
Participant 6 |
Name: |
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Name: |
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Title: |
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Title: |
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If you chose "other", please describe: |
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If you chose "other", please describe: |
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Primary contact? |
Check if primary contact |
Primary contact? |
Check if primary contact |
Site Name: |
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Site Name: |
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Site Description: |
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Site Description: |
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Phone: |
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Phone: |
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| Participant 7 |
Participant 8 |
Name: |
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Name: |
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Title: |
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Title: |
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If you chose "other", please describe: |
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If you chose "other", please describe: |
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Primary contact? |
Check if primary contact |
Primary contact? |
Check if primary contact |
Site Name: |
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Site Name: |
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Site Description: |
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Site Description: |
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Phone: |
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Phone: |
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Email: |
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Email: |
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After completing and
printing this form |
Mail to:
Springboard Schools
181 Fremont Street, 2nd Floor
San Francisco, Ca 94105 |
Fax to:
415 348-1340
Attn: M. Antone |
Please include your PO or check.
Thank You! |
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