One moment please...
Cultivating Civic Champions - Educating for the Practice of Democracy Summit

Welcome! Thank you for your dedication to your craft and the civic education community.

Please use form to register for the Summit.   

*

Prefix
First Name
Last Name
Suffix

*


best email address


please enter a phone you will have access to during events.

Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Registration Information
In this section, please indicate the number of people you are registering and names in the space below.


How many adult attendees are you registering?

How many student ($30/each) attendees are you registering?
Are you an alumnus of any MCCE program? (If you are, please check all the apply!)

You may type additional registration names directly above. If you are registering students, please include their names and grade levels here.
Please include your t-shirt size below. If you are registering more than one person, please include in the blank below.

If registering for more than one person, please include number of shirts and their sizes below.
Accessibility and Equity

Please list any accessibility needs, accommodations, technology, and/or other considerations which may help you and/or your students' accessibility. Please indicate any ASL needs at least two weeks prior to the event.
Additional Conference Activities and Information
Permissions
*
I understand this is a listening tour and a community event wherein we share mutual goals of advancing healthy and meaningful dialogue to better understand each other's perspectives. I will conduct myself with professionalism and kindly and courteously work to ensure all voices are heard.
*
Release. I acknowledge the Michigan Center for Civic Education (MCCE) and its partners may use the likeness, images, video, and names of students and adults affiliated with my school’s participation. I understand the above may be used for press releases, MCCE social media, school communications, video promotions, and other related communications. Should a student, school, or volunteer choose to withdraw from this agreement, the school or participant has an affirmative obligation to submit (e)written notification to MCCE staff at least 48 hours to the start of the event who will acknowledge and (e)sign the document prior to the beginning of an event. Advance notice is important in order to share with appropriate volunteers.
(Optional) Payment Information (Scroll down to submit without credit card payment)
Below is an option to pay via Credit Card.If you are not paying by credit card, please continue to submit. If you are paying by check, please use MCCE's remote (home) office for an address. That is Ellen Zwarensteyn, attn: MCCE, 7096 Summit Hill Ct SE; Caledonia, MI 49316. The business office is also acceptable. The address is MCCE; Attn: Ellen Zwarensteyn, Attn: Conference; 306 Townsend St., Lansing, MI 48933. Please expect 2-3 weeks receipt delay if sending to the office due to COVID.

First Name
Last Name

Please enter the email associated with the credit card above


Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
THANK YOU!
Thank you for championing Civic Education! Your involvement truly makes a difference.