Teach Like a Rockstar

Please complete the following registration form. Each section below will appear as you click the header or next step button. All e-mail addresses that you provide on this form will receive a confirmation e-mail once this registration is submitted. If you prefer to register by FAX, please print the FAXable registration form HERE and FAX to 866.814.0540. Feel free to contact us if you have any questions. Email: Heili@TeachLikeARockStar.com Phone:888.469.3446 x713

» Event Selection

Choose your event:

» Attendees

Please complete the information below for each attendee. All e-mail addresses provided will receive a confirmation.

Please provide a number for each attendee in the event we need to call before or after school hours,
i.e. in the event of a last minute location change, weather related delay, change in parking details, etc.
Please do not use main school number.

	First Name	Last Name	Personal Phone	Email
1
1

» Administrative Contact Information

Your 'Administrative Contact' is the person who approves your attendance, i.e. Principal, Department Head, other Supervisor, etc. If you are attending and paying for this event on your own, then use your own information here.

State: City: District: School or Organization: Administrative Contact First Name: Administrative Contact Last Name: Administrative Contact Email: Administrative Contact Phone:

» Payment Information

Tell us who to bill.

"Bill to" Organization: School, district,or organization to bill. If self-paying, leave this first line blank. Billing Contact First Name: Billing Contact Last Name: Billing Phone: Billing Address: State: City: Zip:

Special Billing Option (Schools / Districts Only):

Payment Method:

Purchase Order Number:

Additional Payment or Registration Info:

» Confirm Order Accuracy

Please check all details. If a red 'X' appears next to any section above or to make additional corrections, do so under the header for that section above. Once all of the information is correct, make sure to click the 'Submit Registration Now' button to process your order.

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Title I Schools

A new requirement under the No Child Left Behind Act states that schoolwide Title I schools are required to dedicate adequate resources to providing o...

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Teach Like A Rock Star T-Shirt

100% cotton pre-shrunk black short sleeve tee with the official Teach Like A Rock Star Screen printed Logo.

Price: $20.00 visit shop

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