Commitment to Equity Institute - Confirm Registration

Commitment to Equity Institute – Confirm Registration

Name*
First Last
Email
School or District Name*
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
I am a...*
Select all that apply
- Teacher
- Student
- Parent / Caregiver
- School Administrator
- District Administrator
- Counselor / Psychologist
- Other
I am registering for:*
Each educator should select and register for ONE of the educator cohorts. Each educator registration is also accompanied with ONE complimentary student registration for the “Learning with Equity” student cohort. (If needed, additional student registrations are also available.)
- "Leading With Equity" Cohort
- "Teaching With Equity" Cohort
- "Learning With Equity" Cohort
I want to register as an:*
- Individual
- Group
Educator Individual Registration
Educator Group Registration
Registering 3 or more educators. Price is per participant.
Number of educators you are registering (including yourself):
Please enter a number greater than or equal to 3.
Please list names and emails of the additional educators you are registering in your group using the fields below.
First Additional Educator Name
First Last
Email
Second Additional Educator Name
First Last
Email
Third Additional Educator Name
First Last
Email
Fourth Additional Educator Name
First Last
Email
Fifth Additional Educator Name
First Last
Email
Student Registration
The Learning for Equity Cohort is for students in grades 7-12
Included Student Registration:
If you chose to include a student registration above, list their information here.
First Last
Student Email:
Do you want to register additional students?*
Remember, you get one free student registration with every educator registration.
- Yes
- No
Additional Student Single Registration Quantity
Please indicate additional student registrations here.
Price: $79.00
Additional Student Group Registration
Registering three or more additional students. Price is per participant.
Price:
Number of students in group:
Please enter a number greater than or equal to 3.
Please list the names and emails of the additional students you are registering.
First Additional Student Name
First Last
Email
Second Additional Student Name
First Last
Email
Third Additional Student Name
First Last
Email
Proceed to Payment
Please select your preferred payment option:
- Payment with credit card or procurement card (via PayPal)
- Invoice and/or Purchase Order Info
Purchase order number
Name for invoice:
First Last
Address for invoice:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Coupon
Total
$0.00
Email
This field is for validation purposes and should be left unchanged.

Commitment to Equity Institute – Confirm Registration

Please list names and emails of the additional educators you are registering in your group using the fields below.

Student Registration

Please list the names and emails of the additional students you are registering.

Proceed to Payment