Professional Development Registration,
On-line Form

Location: 2776 Janitell Road, Colorado Springs, CO 80906
Time: 8:30 a.m. - 3:30p.m.

Workshop includes snacks, lunch and materials necessary to use this program immediately.

* denotes required field.

 

Workshop Info:

HillRAP Start Date
HillWrite Start Date
HillMath Start Date
 
 
Have you completed the prerequisite course for RAP at this time?
(prerequisite on-line course must be completed prior to RAP workshop -
Phonics-Breaking the Code @$99.

Please contact Valen Puhl at alenpuhl@hillsprings.org
in reference to registration)

 


 
 


Personal Info

*Title:
Please select an item.
Gender:
Please select an item.
*First Name A value is required.
*Last Name A value is required.
*Address A value is required.
*City A value is required.
*State Please select a valid item.Please select an item.
*Zip A value is required.
*Home/Cell phone A value is required.
*Primary Email A value is required.Invalid format.
Ethnic Origin (optional)


Work Info

*School District # A value is required.
*School Name A value is required.
*Address A value is required.
*City A value is required.
*State
*Zip
Work Phone
Work Fax
Work Email Invalid format.
Position
How did you hear about us? optional
Referral Name: optional
     
I am interested in graduate credit through
Adams State College


 

 

Payment Info

     
    Enter Amount  
HillRAP Registration Fee $450.00  
HillWrite Registration Fee
(Prerequisite HillRAP)
$450.00  
HillMath Registration Fee $450.00  
Early Bird discount
(3 weeks/21 days prior to workshop)

- $25.00

 
       
Total Amount  
     
Payment Method:  
Name of Facilitator:
   
 
security code Captcha Validation Code 
 

 

If your form does not submit, scroll up to see if you made any mistakes and correct them.

 

After registration receipt, you will be contacted directly in order to provide your payment information. Thank you.

 

Cancellation Policy:Should you need to withdraw from a professional development training course within 7 days prior to the first day of the course, registration fees shall be forfeited or billed in full.

   

Send application and payment to:

2776 Janitell Road
Colorado Springs, CO 80906
valenpuhl @ hillsprings.org
Fax: 719-576-3863