Date:  

My registration is for: (name of school)  
My designation: Primary Participant    Alternate  

Teacher's Name, Last:    First:  

Address 1:    Address 2:  

City   Georgia  ZIP:  

E-mail:     at home   at school
[Note: your e-mail address will only be used to inform you about conference events; it will never be sold or shared with anyone else.]

Phone (home):     (work):  
May we contact you by phone?     Yes    No

Please make your registration check payable to: Macon Arts.

My $20 check is enclosed for the Conference.

Grade level(s) I teach:    K - 5th    Middle School    High School   
Subject area(s) I teach:

   Math   
   Science    
  History/Social Studies    
   Literature    

Curriculum area that I'd most like to infuse with the arts:   

I have a special interest in the following art forms:

   Music    Visual Arts    Theater    Dance    Literary Arts

Questions? Contact Macon Arts at 478-743-6940; info@maconarts.org