Professional Development Registration Form

Tell us about yourself

Full Name: *

Job Title: *

Subject / Grade Level taught: *

School Name: *

School Address: *

District Name: *

Email: *

District emails are heavily filtered; use a personal email to ensure confirmation of your registration and information regarding the session

Phone Number *

Prior to 2021–2022 school year, I have attended Professional Development at MIM. *

Prior to 2021–2022 school year, I have brought students on a field trip to MIM. *

I want to bring my students to MIM when our school resumes off-campus field trips. *

Please check the session you are registering for: *

Tell us how you heard about professional development at MIM *

The Beat e-newsletter from MIM
Email from a MIM team member
Email from another organization (like your district office or school’s administration)
Social Media
Visit to MIM
Word of mouth (colleague)
Word of mouth (family or friend)
Other

If you selected “other” above, please explain: *