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Immediate Immersion Workshop Request Form
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* Indicates required question
Email
*
Your email
Name
*
Your answer
Phone
*
Your answer
School District/Organization
*
Your answer
Address 1
*
Your answer
Address 2
Your answer
City
*
Your answer
State
*
Your answer
Zip/Postal Code
*
Your answer
Country
*
Your answer
What's your budget?
*
Your answer
Would you like an in-person workshop or an online webinar?
*
In-person Workshop
Online Webinar
Which workshop/webinar are you interested in?
*
Immediate Immersion Workshop
Proficiency-based Grading Workshop
Classroom Management Workshop
Building Student Relationships Workshop
Other:
If you chose "other," please specify.
Your answer
How long?
*
Half day (3 hours)
Full day (6 hours)
2 days (12 hours)
3 days (18 hours)
Date Requested (First Choice)
*
MM
/
DD
/
YYYY
Date Requested (Second Choice)
*
MM
/
DD
/
YYYY
Date Requested (Third Choice)
*
MM
/
DD
/
YYYY
Any additional information?
Your answer
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