State NASDSE Contact

Aimee Cain
Center for Educational Networking
(517) 908-3902
acain@cenmi.org

2009-10 NASDSE Professional Development Series
Request Form

Please note that this offer is open to schools, districts, ISDs, and educational organizations in the state of Michigan only.

District/Organization Name (put NA if not applicable)*
Agency Type*	Local school district ISD/RESA/ESA School building Non-profit organization Not applicable
CONTACT INFORMATION Please provide the requested information for the person who should receive the satellite and Internet access information prior to each PD conference.
Contact Name*
Title*
Email Address*
Telephone number*
CONFERENCE DVD NASDSE provides each state with a DVD of each conference. If you would like to receive 1 complimentary copy of the DVD for each PD conference in the series, please complete the information below. Note: DVDs are available approximately 8-10 weeks following each conference.
Do you want to receive a DVD of each PD conference?*	YesNo
Mailing Address*
Mailing Address 2
City*
Zip Code*

* Required