Michigan State Dropout Prevention Summit:
“Moving Students Up Not Out”

August 11–12, 2010
DoubleTree Hotel Detroit/Dearborn
Detroit, Michigan

To register for this event, please complete and submit this online registration form no later than July 30, 2010.

Contact Information

*=required fields

First Name:*
Last Name:*
Title:*
Phone:*
(e.g. 111-111-1111)
Ext:
E-Mail :*
(Please provide an e-mail address that you will be checking during the summer, as important information pertaining to this event will be sent out through August 11.)
Retype E-Mail:*
Organization:*
Street Address:*
Street Address 2:
City:*
State:*
ZIP:*
Organization Type:*





 

If you are from a school, please provide the following details:  
District Name:
Building Name:
School Type:

Are you from a school or district that is participating in the Superintendent’s Dropout Challenge?*

Days of Attendance

Are you attending on behalf of a Title I school or district?*

Which day or days of the conference will you be attending?* (Check all that apply.):

 

Additional Information

Do you have any dietary restrictions?*    
  If yes, please note any dietary restrictions here:
Do you have any special needs? *  
  If yes, please note any special needs here:

Hotel Reservations

 
 I do not need a hotel reservation.
 I will be making a reservation at the DoubleTree Hotel Detroit/Dearborn, and, if necessary, canceling my reservation if my plans change. I understand that if I do not keep the reservation but forget to cancel it, the charge will remain on my personal credit card and I will be billed.

Questions or Comments

If you have any questions or comments about the meeting, please contact Sara Wraight by phone (312-283-2311) or e-mail (sara.wraight@learningpt.org).