MSDE National Board Certification Fall Jump Start 2025

I am attending the following session(s):

All Sessions DO NOT CHECK ANY OTHER BOXES
Day 1 9/19 5:30 p.m. – 8:00 p.m. TOPIC: Component 2, Component 4, and Q&A Segment
Day 2 9/20 9:15 a.m. – 10:00 a.m. General Session
Day 2 9/20 10:30 a.m. – 12:00 p.m. Component 2 and 4
Day 2 9/20 1:00 p.m. – 3:15 p.m. Component 2 and 4
Day 2 9/20 3:15 p.m. – 3:45 p.m. Q&A Feedback
Day 2 9/20 9:00 a.m. – 1:00 p.m. MOC (current MBCT’s up for renewal)

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Mobile Phone *

Personal Email *

Local Affilate *

If other, specify below:

Race/Ethnicity *

Gender *

Pronouns for Name Badge *

Self Description for Name Badge

Allergies/Dietary Restrictions

Please indicate if you have any environmental or food allergies that we should be aware of, e.g. nuts, dairy, gluten.

Is this your first-time attending an MSEA event? *

Yes
No

Is this your first time attending Jumpstart? *

Yes
No

CERTIFICATION AREA

Cancellation Policy

1. Cancellations must occur by NOON Friday, September 5, 2025. You may cancel by emailing [email protected]. If you do not cancel prior to this date, you will forgo any payment for the event and will be assessed any costs incurred by MSEA as a result of the late cancellation. The manager responsible for the event or the MSEA president may waive costs in the case of emergency with appropriate documentation. 2. Barring an emergency reason, cancellations by NOON Friday, September 5, 2025, or no-showing at an event will mean that any costs incurred by MSEA will be passed on to the attendee. 3. Reservations for this event are nonrefundable and nontransferable.

Accommodations and Special Requests

We are committed to providing an accessible event for all participants. If you require any accommodations due to a disability or have any special needs, please describe any necessary accommodations here or contact us directly to ensure that your needs may be met in this event. We will attempt to make every reasonable effort to accommodate your request.

A/V Policy

Video and sound recording is prohibited at MSEA events.

Attendee Information

Attendee's Name *

First

Last

Pronouns for Name Badge *

Allergies

Please indicate if you have any environmental or food allergies that we should be aware of, e.g. nuts, dairy, gluten.

Total

$0.00

Members Only

Cancellation Policy

Accommodations and Special Requests

A/V Policy

Attendee Information