By completing this form you are registering for the program(s) selected. These programs are offered free of charge. Please check the location and dates to ensure that you are able to attend. An email will be sent within 2 weeks of the program start date that lists any additional requirements or information for the program. Thank you for supporting NYS Teacher Centers!

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* 1. Please select the program(s) you would like to register for below:

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* 2. Teacher Center:

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* 3. First Name:

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* 4. Last Name:

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* 5. Email:

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* 6. Home Address:

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* 7. Home/Cell Phone:

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* 8. District:

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* 9. Building:

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* 10. Position:

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* 11. Grade Level/Subject:

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