Name * Address * Personal Email Address * Personal phone number School/Workplace * School District * Subjects/Grades Taught * Years Teaching * Where did you earn your undergraduate degree? * Do you require a room for Friday and Saturday night? * Yes No Local attendees are welcome to participate without staying overnight. Do you wish to have a single room? * Yes, I wish to have a single room and pay a total registration fee of $150 for TEA members or $400 for non-members. No The registration fee for a double-occupancy room is $75 for TEA members, $300 for potential members. Do you have a roommate preference? Rooms are double-occupancy unless attendee chooses to pay increased registration fee for single room. Please list any food allergies or dietary restrictions. Are you a TEA member? * Yes No Do you work more than 75 miles away from Wildersville, Tenn.? * Yes No TEA will cover the cost of a half-day sub if your worksite is more than 75 miles from the location of the retreat (Natchez Trace State Park). TEA will pay for a half-day substitute to allow you time to travel to the retreat if you are more than 75 miles from Wildersville, Tenn. If you would like a sub, please enter your worksite address.