Please fill out the form below to register for the 2011 National Alliance for Partnerships in Equity Professional Development Institute. If you have any questions please call the national office at 610.593.8038.

 

 

* Last Name
* First Name
* Job Position Title
* Organization
* Address
* City
* State
* Zip
* Telephone
* Email address
* I am a  NAPE State Member organization
  NAPE Affiliate Member organization
  STEM Equity Pipeline State Team Member
  Not Currently a Member
  Guest
* Registration Type (Advanced registration)
 State & Affiliate Members - $450
  Nonmember - $550
  Daily - $185 per day
  STEM team member
* I will be attending the conference
 Monday April 11-STEM Leadership Institute
  Full Conference-April 12-14
  Tuesday April 12
  Wednesday April 13-Day on the Hill
  Thursday April 14
* Please include me for
 Monday (STEM pre-con) breakfast
  Monday (STEM pre-con) lunch
  Tuesday-breakfast
  Tuesday-lunch
  Wednesday-breakfast
  Thursday-breakfast
  Thursday-lunch
  no meals
* STEM Equity Pipeline Leadership Institute Pre-Conference. Monday, April 11, 9am-5pm  Yes-I would like to find out more about encouraging women and girls in STEM ($100)
  Yes-I am a member of a STEM Equity Pipeline State Team
  No-I am not interested in the Pre-Conference
* Payment Type (An invoice will be sent to you with payment instructions)  Credit Card
  Check
  NAPE Resource Acct
  STEM Equity Pipeline Funds
  Complimentary (must have code)
Complimentary Code
* Evening out  Yes-please reserve me a ticket - $50
  No I do not want to attend
* Emergency Contact Name
* Emergency Contact Phone #
Special Dietary Needs
Other Special Needs
Would you be willing to facilitate a workshop? (Introduce the speaker(s) and handle evaluations)  Yes please contact me
  No thank you
* denotes required field
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P.O. Box 369, Cochranville, PA 19330  Phone:  610-593-8038  Fax: 610-593-7283  Email:NAPE@napequity.org
NAPE is a 501(c)(6) nonprofit organization