Member ID number: If you do not know your ID number, you can contact member services at 1-800-347-6647 x222 between 8:00am and 7:00pm Eastern time Monday through Friday. If you are a non-member, please enter the account number provided to you for conference registration.
Full Name (as it will appear on the certificate)
Address1
Address2
City State/Province AB AL AK AS AR AZ BC CA CO CT DC DE FL GA GU HI ID IL IN IA KS KY LA ME MB MD MA MI MN MS MO MT NE NV NB NH NJ NM NY NL NC ND NT NS NU OH OK ON OR PA PE PQ PR QC RI SK SC SD TN TX UT VT VI VA WA WV WI WY YT ZIP
Country (only if outside United States)(please cite if Canada)
E-mail * For contact in case of problems with this form. E-mail addresses will not be used for any other purpose, and will not be distributed or shared in any way.
Please check the sessions below that you attended to qualify for this academy. You needed to attend 6 different sessions to qualify.
By clicking submit on this form, you are certifying that all information provided is complete and accurate, and you certify that you attended the opening session, and spent 30 minutes or more in the exhibit hall.
If you have any questions regarding the content of this site or regarding academy certificates in general, please contact Crystal Turner of Learning Resources.
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