WELS Education Conference 1Personal2Service/Membership3Sectionals4Billing This field is hidden when viewing the formToday's date MM slash DD slash YYYY Personal InformationFull name(Required) Select one . . .Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last Suffix First name as it will appear on conference badge(Required)I am presenting a sectional or pre-conference session(Required) Yes No Home address(Required) Address line 1 Address line 2 City State/Province/Region Zip/Postal code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone 1(Required)Phone type 1(Required)Select one . . .CellHomeOfficeOtherPhone 2Phone type 2Select one . . .CellHomeOfficeOtherE-mail(Required) Enter e-mail Confirm e-mail Dietary restrictions and/or special needsEmergency ContactContact name(Required)Relationship to attendee(Required)Day phone(Required)Evening phone(Required) Current Service or MembershipChurch/School(Required)City(Required)State/Province(Required)Select one . . .AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonSchool role(Required)Select all that apply. School Leader - Early Childhood Ministry Teacher - Child Care School Leader - Elementary School Teacher - 3K/4K School Leader - High School Teacher - 5K Pastor Teacher - Elementary Staff Minister Teacher - Middle Other Teacher - High School Other school role(Required) Conference SelectionsReference the website for sectional descriptions. Select a registration option(Required) Pre-Conference Full Conference Full Conference + Pre-Conference Monday One-Day Pass Monday One-Day Pass + Pre-Conference Tuesday One-Day Pass Tuesday One-Day Pass + Pre-Conference Pre-Conference 1 to 5:15 p.m.(Required)Select one . . .EC: Child Development (J. Sallquist) & Outreach Strategies (C. Holman/ D. Dobberstein)NWEA MAP Growth & MAP Reading Data (J. Williams)Supporting Students Impacted by Trauma (A. Schoof)Grant Writing Process (Kelly Ramirez) & Advanced Grant Writing Strategies (Dr. Keshia Swaringam)NoneSectional 1(Required)Select one . . .Assess: Data-Based Decision Making (N. Gartner)Care: Strong School Culture (K. Festerling)Cultivate: Nurturing the Faith of a Child (K. Wegner)Collaborate: High-Preforming Teams (S. Luehring)NoneSectional 2(Required)Select one . . .Assess: Early Literacy: Brain Research & Dialogic Conversation (L. Deering)Assess: Backwards Planning (J. Krause)Care: Systems & Routines (H. Hensel)Cultivate: Ministry Team that Soars (C. White, J. Herring, R. Radue)Collaborate: Triple A Feedback (A. Bitter)NoneSectional 3(Required)Select one . . .Assess: Early Literacy: Phonological, Phonemic Awareness, and Phonics (L. Deering)Assess: Real-Time Insights (J. Van Acker)Care: Proactive Strategies for Challenging Behaviors (R. Youngblom)Cultivate: Neighbor Congregations Work Together (R. Guenther, N. Scharf)Cultivate: Connecting with our Communities (M. Lawrenz, J. Hein)Collaborate: The PLC Model (L. Montez)NoneSectional 4(Required)Select one . . .Assess: Early Literacy: Pillars of Reading & Interactive Read Aloud (L. Deering)Assess: Transforming Grading to Reflect Learning (J. Kjeer)Assess: EC Assessment, Observation and Documentation (E. Melott)Care: Collaborative Approach to Student Support Pt. 1 (M. Pucci, V. Weiss)Cultivate: Beyond Confirmation (B. Steenbock, B. Reichel)Cultivate: Building a Solid Financial Plan (J. Lemke)Collaborate: Moving from PLC Lite to PLC Right (A. Goede)NoneSectional 5(Required)Select one . . .Assess: Early Literacy: Choosing Vocabulary (L. Deering)Assess: I Taught it…Now What? (N. Gartner)Assess: EC -Using Observation Data (K. Gut)Care: Collaborative Approach to Student Support Pt. 2 (M. Pucci, V. Weiss)Cultivate: Congregation Mergers (J. Hein)Cultivate: God-Pleasing Self-Care and Ministry Commitment (S. Herkstroeter)Collaborate: Curriculum Design & Planning Tools (M. Moeller)NoneSectional 6(Required)Select one . . .Assess: Mindsets on Norm-Referenced Assessments (C. Bartsch)Assess: EC Communicating with Families (J. Mehlberg)Care: Resilience Through Christ-centered SEL (R. Wolle)Care: Supporting Student Needs through State Funded Programs (M. Murphy)Cultivate: Spiritual Sustainable Ministry (J. Laitinen)Collaborate: Working Genius: Maximizing Traction (J. Oldenburg)NoneThis field is hidden when viewing the formSectional 7(Required)Select one . . .Cultivating Compassion (Jeremy Bakken and Rev. Ray Schumacher)Building on the Solid Foundation (Rev. Kyle Bitter)Early Learning Standards and Learn by Play (Becky Lindenberg/Janine Thies)Using Technology to Spark Creativity and Higher Order Thinking Skills (Rachel Feld)Supporting Social and Emotional needs of Children with Autism Spectrum Disorder (Dr. Rachel Youngblom)Effective Strategies when using MAP Data (Michael Koestler)NoneThis field is hidden when viewing the formSectional 8(Required)Select one . . .Books Build Better Brains: How Promoting Literacy is Key to Early Brain and Child Development (Dr. Navsaria)Supporting the Emotional Health of Teachers: Resources for Care from Christian Family Solutions (Dan Nommensen)Called to be a Witness (Rev. Earle Treptow)The “Who Am I?” Crisis Among Teens Today (Rev. Phil Huebner)NoneSelect t-shirt size(Required)All Conference attendees will receive a conference t-shirt. Please select your preferred size. X-Small Small Medium Large 1XL 2XL 3XL 4XL 5XL Do you have interest in serving in a worship service check all interest areas: Choir Musical instrument Usher Communion assistant Are you interested in participating in the Lambeau Stadium and Hall of Fame tour?Group tours will be at an additional cost. You are not obligated to participate if you selected yes, but this data will help us with planning to ensure enough tour times are available for those interested. Yes No Conference fee Price: Discount code Total $0.00 Verify total(Required) Total fee is correct. Proceed to Billing section My total is $0 If your total is zero after entering a discount code, please proceed to the privacy policy and then press the Submit button to finish your registration process. Refund policy: Refunds that are requested in writing before May 31 are subject to a $50 non-refundable charge. No refunds can be made after May 31.Billing InformationCredit or Debit card information(Required) DiscoverMasterCardVisaSupported Credit Cards: Discover, MasterCard, Visa Card number Month010203040506070809101112 Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Expiration date Security code Name on card Billing address(Required)The address you enter must match the address on file with your bank/credit card company. If the address is not correct or if required fields are left blank, an error message will display. Same as home address (MUST MATCH WITH BILLING STATEMENT) Address line 1 Address line 2 City State/Province/Region Zip/Postal code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Data Privacy & Permission(Required) I AGREE with the terms of the WELS Privacy Policy.NOTE TO EU CITIZENS, RESIDENTS, TOURISTS, AND OTHER PERSONS TEMPORARILY IN THE EU: By submitting this form you consent to any and all information you provide and submit via the site being sent to the United States of America. The United States has not sought nor received a finding of “adequacy” from the European Union under Article 45 of the GDPR. WELS relies on derogations for specific situations as set forth in Article 49 of the GDPR. You are also informed that the United States presently does not have an adequate level of personal data protection as determined by the European Commission’s adequacy decision on October 6, 2015 (case c-362/14) and articulated in the European Union’s General Data Protection Regulation and has not received a similar designation of adequacy by any other foreign data protection authority. You agree to the transfer of your data and personal data to the United States, however, to be used in accordance with WELS Privacy Policy. Δ WELS Education Committee: [email protected] Ref: WELS Education Conference