Editing previous response:

Please fix the highlighted areas below before submitting.

The TIM Academy Summer Training Registration

$1,350 fee includes all materials

Please fill out form below to register.
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:"

To pay by check, please type your PO # or contact Michelle McGurl with the information and click "submit."

Answer required for "To pay by check, please type your PO # or contact Michelle McGurl with the information and click \"submit.\""