Director's Institute Registration Form

Entry Level (Digital ONly

Institute Fee: $50.00

Includes 5 hours of training and a copy of the book "Building on Whole Leadership". You may select a one day option -Friday Oct 22, 2021 in person, or four Friday\'s (Nov 5, Dec 3, Dec 10, Dec 17), 2021 as a virtual option

Are you an NAEYC Member*

YESNO

NAEYC membership number (if applicable)

I am not a NAEYC member, but want to add a membership to my registration

YES, please process my membership
No, not at this time

Membership Options

Entry Level- Digital ONLY- $30.00
Standard Level - Printed Journals and a Book- $69.00
Premium Level- Both Journals, Free BOOKS, $150.00

First Name *

Last Name *

MOPD ID -Required for Missouri Residents to have their training hours recorded into the OPEN database

Email Address*

Address *

City*

State*

Zip*

Work Affiliation

Work Address

Phone number (cell, work, or home)*

I wish to attend the following day(s)

Friday-Oct. 22, 2021- in-person- - at UMKC Student Union Theater - 9:00 a.m. -3:45 p.m.
Four Friday's (Nov 5, Dec 3, Dec 10, Dec 17) - virtually- 10:00 a.m. - 11:15 a.m.

Today's Date *

Payment Instructions

I understand that an invoice will be generated and returned to the sender by email for payment with a credit card, through PayPal-WITHIN THE NEXT 48 HOURS. I understand no Pay Pal account is required to process the payment.