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NBCT Policy Summit
Online Registration Form

*First Name:

*Last Name:

*Home Address:

*City:

*State:

*Zip:

Home Phone:

Work Phone:

*Home/Summer E-mail:

*Confirm Home E-mail:

School District:

School Building:

*Are you an NBCT?:	Yes No

Grade Level/Content Area:

Years in Education:

School E-mail:

Small Group Discussion:
*1st Choice
2nd Choice
3rd Choice

For further information, please contact Kayetta Meadows at The South Carolina Education Association. kmeadows@thescea.org or 803-772-6553.

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A Quality Teacher for Every Child, in Every Classroom, in Every School in South Carolina