Individual Registration

Name

This field is for validation purposes and should be left unchanged.

Prefix*

Name*

Name on Badge

School/Organization*

Role*

Role - Other*

Professional Area of Focus

Professional Area of Focus - Other*

Address*

Phone*

Email*

List any Dietary Restrictions (enter “N/A” if none)*

Will you be in attendance for lunch?*

Yes, I will be attending.

No, I will not be attending.

Will you be in attendance for the social gathering?*

Yes, I will be attending.

No, I will not be attending.

Will you be in attendance for lunch?*

Yes, I will be attending.

No, I will not be attending.

Will you be in attendance for the mentor teacher dinner?*

Yes, I will be attending.

No, I will not be attending.

Will you be in attendance for the concluding lunch?*

Yes, I will be attending.

No, I will not be attending.

Please select the appropriate registration type below and complete the checkout process. Note that registrations are not complete until payment has been received through PayPal when you submit or by GaDOE/GaPSC Options below.

Which registration category applies to you?*

Institutional member registration

Non-member registration

Invited attendee (no payment required)

Institutional members registration fee*

Non-member registration fee*

Mail your check payable to GACTE to the following address: c/o Yasar Bodur Bodur, GACTE Treasurer, Georgia Southern University College of Education, PO Box 8013, Statesboro GA, 30460

If the completer of this form is different from the registrant, please list the name of the individual completing the form below.

If you are completing this registration for someone else, please include your contact information here:

Submittee's Email

Submittee's Phone

Please check your SPAM Folder for email Confirmation if you do not see it in you inbox.

PLEASE NOTE: GACTE reserves the right to take and use images/photos or recordings of meetings or meeting-related events and its participants. Authorization is implicit upon attendees’ registration to the bi-annual meeting or other events.

Total

Payment Method*

Pay online with PayPal

Pay by check

Payment by PayPal

Payment Method

Pay by check

Payment instructions will be emailed to you.