Registration for CPAM Leadership Seminar - Wednesday, September 28, 2022

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CPAM Leadership Seminar Registration Form for PayPal payments only.

If you are registering for the CPAM Leadership Seminar on September 28, 2022 either in-person, via Zoom, or asynchronously and paying with PayPal please complete this form.

For more information visit https://cpam.org/seminar

Email *

Check the appropriate box(es). *

$15 -- CPAM member registration fee

$45 -- Nonmember registration fee for awardees (includes membership for 7/1/22 - 6/30/23)

$45 -- Guest Registration fee

Required

Last Name *

First Name *

Nickname / First Name for Badge *

Year of Award *

Award State *

Grade Level *

Elementary

Secondary

Required

Select your appropriate grade band *

K-4

5-8

9-12

Personal Phone Number Including Area Code *

How will you be attending *

Will attend in LA

Will attend via Zoom

Will participate asynchronously

Guest Information. Please make sure you include guest payment.

If you do not have a guest, you can skip the next section.

Guest's last name

Guest's first name

Guest Nickname / First Name for Badge

Guest's grade band

K-4

5-8

9-12

Clear selection

Guest Phone Number Including Area Code

Guest's Email address

How will your guest be attending

Will attend in LA

Will attend via Zoom

Will participate asynchronously

Clear selection

Clear form

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