Brown Bag Advocacy Registration

  • Contact Information

  • Credentials

    If you are seeking continuing education hour credits, please provide the following information.
  • This field is optional. We are asking for credentials such as: LCDC, PRSS, RSPS, or PSS
  • This field is optional. We are asking for your professional license or certification number to be printed on your certificate of completion.
  • Demographics

    Please provide the following information so that we can evaluate diversity, inclusion and equity. All information provided will be kept confidential.
  • This is used to determine your district / region and whether you live in an urban, suburban or rural area.
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  • If you have a disability that requires a reasonable accommodation in order to participate, submit that request here. Otherwise, leave it blank.