Attendee Name*

First Last

Registration Type*

I am a current IDA member ($35)
I am not an IDA member ($45)

IDA Member Number

If you do not have your IDA member number, please email IDA at member@interdys.org and enter your number before completing your registration. If you register as an IDA member but do not enter your correct member number, your registration will be returned.

Attendee Address*

Street Address Address Line 2 City State ZIP Code

Attendee Phone

Attendee Email*

School District / Business Name*

What is your primary interest?*

PO Number

Invoice to be mailed to:*

Street Address Address Line 2 City State ZIP Code

Email Address of Invoice Recipient*

PO REGISTRATION FORM

Early Childhood Literacy Institute

with Susan E. Miller

February 27, 9:00am-12:30pm CST via Zoom