JILL TRINKA Workshop

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Registration Form for NJSMA Elementary Music Division Columbus Day Workshop
Date: Monday, October 8, 2018
Time: 9:30am-3:30pm. (Registration at 9:00am)
Location: The Mansion at Mountain Lakes (90 Rt. 46 East, Mountain Lakes, NJ)
$90 Registration fee includes: Workshop, Continental Breakfast, Buffet Lunch and SWAG bag
Jill Trinka Resources will be available for purchase. (cash/check only)
PD Certificates will be provided.
Email elementary@njsma.com with any questions.
Lisa Wichman, NJSMA Elementary Music Division Chairperson
Carol Richardi, NJSMA Elementary Music Division Co-Chair, Registrar
If your school is paying by Purchase Order, please share the below information with your business office:
Our official name is: North Jersey School Music Association. The organization address is: 819 Belmont Drive Hackettstown, NJ 07840. The Tax ID# is 22-3629391.
Registration fee payable to NJSMA.
Mail check or purchase order to: Carol Richardi, Registrar, 200 Monroe Ave, River Edge, 07661
IF YOU ARE REGISTERING AFTER 10/2, YOU MUST PAY AT THE DOOR, CASH OR CHECK.

JILL TRINKA (10/8/18) Workshop Registration Form

NJSMA Elementary Music Division Columbus Day Workshop

Name (first, then last): *

School district *

School name *

School town and state *

Preferred email address *

What grades do you currently teach? *

If you have dietary restrictions, please explain below. (i.e. gluten free) The venue provides gluten free options. *

Check one: *

Region 1 (North Jersey School Music Association)

Region 2 (Central NJ)

Region 3 (South Jersey)

Other:

How did you hear about the workshop? *

NJSMA website

NJMEA facebook page

NJSMA Elementary Music Division facebook page

Colleague

Email from NJSMA

Other:

Required

Indicate method of payment. *

Registration fee payable to NJSMA. Mail check or purchase order to: Carol Richardi, Registrar, 200 Monroe Ave, River Edge, 07661. I understand that I am not considered registered until either a check for $85 or notification of PO processing has been received.

$90 Check payable to NJSMA

$90 Purchase Order

Clinician

Thank you for completing the registration form. PD certificates will be provided at the conclusion of the workshop. You will receive registration confirmation via email upon receipt of either a check or PO.

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