Register for Professional Development Courses for Teachers

1 Workshop

2 Teachers

3 Student Teachers

4 Emergency Contact

5 Payment and Terms

Teacher Names and Emails
Use the plus sign next to the email field to add more teachers
Teacher Names and Emails*
First Name Last Name Email
Add All Attendee Names
Administrators
One administrator can attend for free per teacher registration.
Use the plus sign next to the email field to add more administrators.
Will an administrator be attending?*
- Yes
- No
Administrator Name and Email*
First Name Last Name Email

How Many Student Teachers Are you Registering Today?
Total Number of Student Teachers*
Must present student ID on day of workshop to receive reduced rate; cannot be combined with other discounts/offers.
Student Teacher Rate*
Price: $50.00
Names of Student Teachers Attending
Use the plus sign next to the email field to add more student teachers
Student Teacher Names
First Name Last Name Email

Contact Information for Cancellations
In the event of a workshop cancellation due to inclement weather or other reasons, we will contact you at the following.
Cell Phone for Use in Emergency*
Email*
Enter Email Confirm Email

Billing Contact
Provide full contact details for person responsible for receiving Strobel Ed invoice.
Name of Person*
First Last
Email*
Phone Number*
School Name*
School Address*
Street Address Address Line 2 City State ZIP Code
School Principal Name*
Principal's Email*
Payment Details
Current Total
$0.00
How will you be paying?*
- Credit Card
- Personal Check
- Purchase Order
Coupon
Personal Check Details
Personal Check Number
Note: If paying registration by personal check, your reservation will be held for 10 days; reservation is subject to cancellation if payment is not received within 10 days.

Mailing address to send payments by check: (Remember to include registrant's name, workshop name and date, and email and phone number.)
Strobel Education
8966 Kleeman Drive
Tell City, IN 47586
Purchase Order Details
P.O. Number*
Credit Card Details
Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Terms and Conditions
Please read our terms*
- I have read and agree to all Strobel Education policies.
Lastly, how did you learn about Strobel Education?*
Unique ID
Comments
This field is for validation purposes and should be left unchanged.

Workshop Registration

First Name	Last Name	Email

First Name	Last Name	Email

First Name	Last Name	Email