From Obstacle to Equity: Transforming Your Pathway Master Schedule Into a Tool for Equity

Thursday, May 12, 2022 12:00-4:00pm PT | 3:00-7:00pm ET

Registration and Payment Form

Campaign ID

Payment Required?

YesNo

EVENT NAME

DATE

Form Instructions

Please fill out this form for your entire team once; only one representative from each team needs to fill out this form.
We highly encourage participants to attend as part of a team from a school or district, but individuals are welcome.

If you are registering multiple teams, please fill out this form multiple times.

Registration Confirmation

Please indicate below which email address the registration confirmation email should be sent.

Registration Confirmation Email

I am registering on the behalf of the participant(s) below and I will not be attending the workshop seriesIf you are registering on someone's behalf, please ensure that their contact info, pronouns, and role - not yours - are reflected below.

Registering on Behalf of Team Member(s)

Please fill out the remainder of this form - except for "Your Name" and "Your Email" directly below - as if you were the participant(s), not yourself.

Your Name

Your Email

Additional Participant Details

First Name

Last Name

Phone

Pronouns

How should we refer to you if not by name?

How should we refer to this participant if not by name?

Additional Participant's State

Additional Participant's Country

Additional Participant Affiliations

Participant's Job Title

Full Pathway Name

School Selection (Start typing in your school's full name, no acronyms)

The school is not listed

Full School Name

District Selection (Start typing in your district's full name, no acronyms)

The district is not listed

Full District/LEA Name

This participant is not affiliated with a pathway/school/district.

Pathway ID

School ID

LEA ID

You have indicated that the appropriate organization does not fit the criteria above. Please add the relevant information below for our records.

Which type of organization is this guest affiliated with?

CorporationNon-ProfitOther Organization

Organization Name

Will this participant be attending From Obstacle to Equitable: Transforming Your Pathway Master Schedule Into a Tool for Equity?

YesNo

Please describe any accessibility-related accommodations that will facilitate this participant's full participation in this event. A member of the LLA team will be in touch with this participant shortly to coordinate the request.

In order to add more guests, please click the "Add another guest" button in the bottom right hand corner ------------------------------------⬇︎

Payment Information

Do you have a discount code to input? (If you are not sure, click "No")

YesNo

Discount Code

Discount Amount

Total Amount to be Charged

How will you be paying for the workshop?

Purchase Order (PO)

Credit CardDirect Debit/ACH Payment

Credit Card Information

Full Name on Card

Card Number

Exp. Month (MM)

Exp. Year (YY)

CVC Code

Billing Details

First Name

Last Name

Address Line 1

Address Line 2

City

State/Province

Postal Code

Country

Bank/ACH Information

Name on Account

Bank Name

Bank Routing Number

Bank Account Number

Account Type

CheckingSavings

Billing Details

First Name

Last Name

Address Line 1

Address Line 2

City

State/Province

Postal Code

Country

Purchase Order Information

Purchase Orders can be made out to:
Linked Learning Alliance
730 Harrison St, 3rd Floor
San Francisco, CA 94107

PO Number

Billing Email

Billing Phone Number

From Obstacle to Equity: Transforming Your Pathway Master Schedule Into a Tool for Equity

Registration and Payment Form

Please fill out this form for your entire team once; only one representative from each team needs to fill out this form. We highly encourage participants to attend as part of a team from a school or district, but individuals are welcome.

In order to add more guests, please click the "Add another guest" button in the bottom right hand corner ------------------------------------⬇︎

Please fill out this form for your entire team once; only one representative from each team needs to fill out this form.
We highly encourage participants to attend as part of a team from a school or district, but individuals are welcome.