Registration

* Required fields

Training Institute
Select an Institute Location and Date *

Attendee Information

First Name *

Last Name *

You will receive a "Certificate of Completion" at the conclusion of this program. As a courtesy and to ensure your name appears correctly, please enter your name above as you would like it to appear on the certificate.

If you have any special characters or accents in your name, please check this box and contact Dee Roeder.

Program Name *

Job Title

Role In Program *

Parent/Family member

Staff

Please enter your home OR program address according to where you would like to receive your training confirmation:

Address *

City *

State *

Zip code *

Phone

Fax

Email (enter '@nomail' if none) *

Is the address above your home or program address? *

Home

Program

Do you have any special needs or dietary restrictions?

Would you like to share your contact information with fellow participants? *

Yes

Registration Profile

How did you hear about the FPI trainings? *
Other (please specify):

Work Setting/Area of Interest: (check all that apply) *

	Infant/Toddler		Middle/Secondary
	Preschool/Pre-K		College Students
	Kindergarten		Families
	Primary/School age		Other

Other (please specify):

Pre-Institute Survey

We ask that you take some time to give us some information prior to your arrival at the institute so that we can get to know some of the skills, information, and questions each participant will bring to the training.

How many years have you been involved with teacher/family partnerships?

How do you define family partnerships?

Share one or two of your experiences regarding staff-family partnerships?

What do you hope to learn at this Institute?

Payment and Confirmation

Payment Method: *
The registration fee is $25 per person. Fee includes continental breakfast, lunch, refreshments, and printed materials provided at the Institute. You may pay online now with a MasterCard or Visa credit card or mail in a check or money order. Payment must be received two weeks prior to the Institute date. Your seat will not be reserved until payment is received.

Credit Card

Check/Money Order

If paying by credit card, you will be directed to enter that information on the next screen. Please have your card ready.

Please enter the email address where you want your registration confirmation sent: *

Please click the "Submit" button once to confirm your registration.