Workshop Registration Form

PD Collab Workshop Registration Form
Name*

First NameLast Name
Hours/PDPs Earned
To be completed by instructor
Payment Log
To be completed by Finance Dept.
Attendee Email*
A confirmation of your registration will be sent to this address. If not using school email, additional information may be needed to confirm your membership.
Personal Phone
Non-School Number (for weather/cancellation, etc. purposes)
Role
Please provide your content area and grade level information in the space below.
Workshop Details

The following section should autofill from your registration link. Skip to "Checkout" section
Workshop Title
Presenter Email
Dates
Meeting Times
Location
Hours/PDPs
Checkout
Collaborative Member Status*
In order to calculate your workshop fee, please select the appropriate member status from the list below. If you are unsure of your school or districts membership status, visit https://www.pdcollab.org/membership
Member District*
Choose your school or district from the list
Cancellation Policy

If the workshop is cancelled due to low enrollment, you will be refunded your enrollment fee automatically. If the workshop runs but you do not attend, you will still be charged unless you contact us at least 5 days in advance to request a refund.
Payment Options

For electronic payments, please make sure you select the fee in the shopping cart that MATCHES the fee shown above. Our accounting folks thank you! To pay by PO, you will need a PO number and accounts payable contact email.
Non-Member Fee
Premium Member Fee
Payment Type*

Not Applicable - FREE (2 or 5 hr workshop Member Rate)Electronic payment (Credit Card or Bank Transfer)Purchase OrderPersonal Check (NOTE: Registration will not guaranteed until check is received)
PO Number
Accounts Payable Contact
Enter the email address of the person to whom the invoice should be sent

Online Cart

15 Hr Workshop - Member

$25.00

15 Hr Workshop - Non-Member

$100.00

2 Hr workshop - Non-Member

$25.00

5 Hr Workshop - Non-Member

$50.00

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

PD Collab Workshop Registration Form

Workshop Details

Checkout

Cancellation Policy

Payment Options