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The TIM Academy Registration Form

June 16-19, 2026 (3.5 Days)

Please complete the form below. Required fields marked with an asterisk *

Participant Name: *

Answer required for "Participant Name: "

Professional ID (For ACT 48 Hours ONLY):

Answer required for "Professional ID (For ACT 48 Hours ONLY):"

Email Address:*

Answer required for "Email Address:"

School District:*

Answer required for "School District:"

Street Address*

Answer required for "Street Address"

City*

Answer required for "City"

Zip/Postal*

Answer required for "Zip/Postal"

Daytime Phone Number:*

Number Required

Years of Experience*

Answer required for "Years of Experience"

Current Position:*

Answer required for "Current Position:"

Student Age Range:*

Answer required for "Student Age Range:"

Confirmation Email

Answer required for "Confirmation Email"