Summer SPLASH Registration

Summer SPLASH Registration

**Please use the Network Registration Form if your school belongs to the Illinois Middle Grades Network.

College Students please use the Student Registration Form to receive the student rate.

Conference Rate - $175

NAME & CONTACT INFORMATION
First Name: *

Last Name: *

Address: *

City: *

State: *

ZIP Code: *

Phone: *

Email: *

SCHOOL INFORMATION
If school is providing your registration, please provide your school information below.

School/District Name:

School Address:

City:

State:

ZIP Code:

School Phone:

Contact Email:

PERSONAL INFORMATION
Please tell us about yourself:

Position: *

Dist. Admin. Bldg. Admin. Teacher Soc. Services N/A

What position do you hold at your school/district?

Subject: *

LA/ Reading Math /Sci SS /Hist Fine Arts Ind Arts /Tech PE/Health N/A

What Subject(s) do you teach?

Grade Level: *

1-4 5 6 7 8 9-12 N/A

Which grade level(s) do you teach?

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Summer SPLASH Registration