NJSMA Elementary Music Division
2015 Columbus Day Workshop
(Please print neatly, or complete electronically)
Date: ___________________
Name _____________________________________________________
School District ______________________________________________
School _____________________________________________________
School Address _____________________________________________
_____________________________________________
Email: _____________________________________________________
List the grades you currently teach: ______________________
If member, NAfME membership # _________________________
(Please include a photocopy of an up-to-date NAfME membership card)
Please enclose registration fee: Checks/Purchase Orders made payable to NJSMA
(check one)
$50- Current NJMEA/NAfME member _______
$65- Non-member _______
$75 – after 9/12/15 _______
Paying by purchase order? Check here: ______
Check one: Region 1 (NJSMA) ____ Other: ______ (please explain) _____________________________________
How did you hear about the workshop? _________________________________
Questions? Email: lwichman@njsma.com
To register, mail*completed form and registration fee to:
Carol Richardi, NJSMA Workshop Registrar
200 Monroe Avenue, River Edge, NJ 07661
*Or email registration form electronically to lwichman@njsma.com
***You will receive a confirmation email after registering***