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Learning Forward Illinois Membership
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Last Name:
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First Name:
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Primary Email Address:
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Confirm Email Address
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Secondary Email Address (We will use this one only if the primary address does not work; put NA if not applicable)
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District/Organization:
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Professional Title
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Administrator/Building
Administrator/Central Office
Superintendent/Assistant Superintendent
Teacher
Curriculum Coordinator
Director of Professional Learning
Coach
Other:
What is your role in professional learning (PL)?
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I develop/create PL opportunities
I support implementation of PL
I evaluate PL
I guide decision making for PL
Other:
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Mailing Information
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Street Address
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City
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State
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Zip Code
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Preferred Phone Number:
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