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KENTUCKY EDUCATION ASSOCIATION

Uniting, Organizing, Empowering Members



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Let's Talk Registration


Let's Talk Registration fees can be paid with a Purchase Order or with a Credit Card. Payment is required to complete this form. If paying by Purchase Order, have your Purchase Order information prepared to be included below.

First Name:
Last Name:
 
Personal Email: (non-work email address preferred)
 
Address:
City:
State:
Zip:
 
Home Phone:
Cell Phone:
 
Do you have dietary restrictions?
Yes
No
 
School District:
School:
 
With which grade levels do you work?
What subject(s) do you teach?
 
Are you a KEA Member?
Yes
No
Are you a National Board Certified Teacher (NBCT)?
Yes
No
 
Total number of classroom teaching experience:
0-2
3-5
6-7
8-10
11-15
16-20
21-25
26+
Not a teacher
 
What is your role?
Teacher
Principal
Paraprofessional/Instructional Aide/Aide
Pre-service Teacher
Higher Education Facility
District Administrator
KDE Staff
KEA Staff
Prichard Committee Staff/Member
Conference Presenter
Other
 
Day 1 - Would you like to attend a Class?
Yes
No
 
Day 1 - Class:
Classroom Culture
Equity
Social Justice
NBCT PLF Certification
NBCT Renewal Training
 
Day 1 - If you chose Classroom Culture specify your area of focus?
Elementary
Middle
High
 
Day 2 - Would you like to attend Breakout Sessions?
Yes
No
 
Day 2 - Please select one option for each of the four sessions:
 
Day 2 - Session A - (9:00am - 10:30am)
 
Day 2 - Session B - (10:30am - 12:00pm)
 
Day 2 - Session C - (1:00pm - 2:30pm)
 
Day 2 - Session D - (2:30pm - 4:00pm)
 
Name that will be printed on your identification badge:
 
Payment Method:
If selecting Credit Card, you will be prompted to complete your payment using a Pay Now button on the next screen after clicking Submit and you can leave the Purchase Order fields below blank.

If selecting Purchase Order, you must complete the Purchase Order fields below.

Credit Card
Purchase Order
 
Let's Talk Fee Schedule
 
Purchase Order Number:
Purchase Order Contact:
 
Purchase Order Address:
Purchase Order City:
Purchase Order State:
Purchase Order Zip:
 
Purchase Order Phone:
 
Purchase Order Email: