2024 State Convention

Preconference- June 17th

Conference - June 18 & 19

Gilbert High School, Gilbert, Iowa

All registered individuals MUST be a current member of SHAPE Iowa.

Link to SHAPE Iowa Membership form

School District you are affiliated with. (Adair- Casey to Prairie Valley Community School Districts)

School District you are affiliated with. (Red Oak to Woodward-Granger Community Schools)

Other

Please fill out this section with whom should be contacted with any questions about this registration if needed.

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Zip Code *

Phone *

Email Address (that you would like to be contacted by) *

Professionals please select your teaching level. *

Please check if you will need have special dietary needs. *

yes

no

Please use the following area below to add any others you will be registering.

Last Name

First Name

Email address of additional individual attending the convention

Professionals please select your teaching level.

Please check if you will need a gluten free lunch.

yes

no

Last Name

First Name

Email address of additional individual attending the convention

Professionals please select your teaching level.

Please check if you will need have special dietary needs.

yes

no

Last Name

First Name

Email address of additional individual attending the convention

Professionals please select your teaching level.

Please check if you will need a gluten free lunch.

yes

no

Last Name

First Name

Email address of additional individual attending the convention

Professionals please select your teaching level.

Please check if you will need have special dietary needs.

yes

no

Last Name

First Name

Email address of additional individual attending the convention

Professionals please select your teaching level.

Please check if you will need a gluten free lunch.

yes

no

Last Name

First Name

Email address of additional individual attending the convention

Professionals please select your teaching level.

Please check if you will need have special dietary needs.

yes

no

Last Name

First Name

Email address of additional individual attending the convention

Professionals please select your teaching level.

Please check if you will need a gluten free lunch.

yes

no

Last Name

First Name

Email address of additional individual attending the convention

Professionals please select your teaching level.

Please check if you will need have special dietary needs.

yes

no

Please note that the price of the full 2 day conference will increase to $160 on June 10, 2024.

NO REFUNDS AFTER JUNE 10!

Convention Registration - Please enter the number of Registration fees that will be paid for on this form. (Zeros need to be filled in) *

	Student Price Full 2 day Convention Registration (includes Lunch on Tuesday) $60
	Full 2 day Convention Registration (includes Tuesday lunch on T) $140
	Full 2 day Gilbert employee registration (includes lunch on Tuesday)
	Single day Convention Registration for Tuesday, June 18 (includes lunch) $90
	Single day Convention Registration for Wednesday, June 19 $70
	PreConvention - Monday June 17 $20
	Extra- Adult CPR/AED/First Aid $50.00 (for coaching only)
	Extra- Adult and pediatric CPR/AED/First Aid $60.00

Current Total:

$0.00

Required *

I have made sure that all information is correct.

Elementary	Middle School	High School	K-12
College/University	Community Agency	Other

Elementary	Middle School	High School	K-12
College/University	Community Agency	Other

Elementary	Middle School	High School	K-12
College/University	Community Agency	Other

Elementary	Middle School	High School	K-12
College/University	Community Agency	Other

Elementary	Middle School	High School	K-12
College/University	Community Agency	Other