AFSA Convention 2022 Registration AFSA Convention 2022 Registration Form This form is for all AFSA members (including delegates, alternates and guests), as well as all speakers, sponsors, exhibitors and staff who will be attending the 16th Constitutional Convention in San Juan, Puerto Rico. Please fill in this form and click on SUBMIT to file your registration form. Fields with a RED * are required. If you have any questions, call the AFSA National Office at (202) 986-4209 or e-mail afsa@AFSAadmin.org. Salutation Mr.Mrs.Ms.Dr.Other Salutation First Name * Last Name * Address * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Please Upload a Copy of Your Vaccination Card Drop a file here or click to upload Choose File Maximum file size: 419.43MB Primary Phone Number (numbers only) * Cell Phone (if different, numbers only) Email (personal email preferred) * Your AFSA Local Number, use the dropdown to select your local, if you cannot find it, INDIVIDUAL RETIREE, SPEAKER, GUEST and OTHER are at the end of the dropdown list. * Please use this dropdown menu to select your AFSA Local1 New York, NY1C New York, NY Retirees2 Chicago, IL3 San Francisco, CA3E San Francisco, CA Retirees4 Washington, DC6 Boston, MA8 Yonkers, NY8C Yonkers, NY Retirees9 Woodhaven, MI10 Buffalo, NY11 Wyandotte, MI13 Bloomfield, CT18 New Haven, CT20 Newark, NJ22 Hartford, CT25 Baltimore, MD27 Shelton, CT28 Detroit, MI36 Howard County, MD42 East Hartford, CT42A Griswald, CT42F Cromwell, CT42H North Stonington, CT42K East Haddam, CT42N Watertown, CT44 St. Louis, MO44C St. Louis, MO Retirees48C Region 16, CT48L Madison, CT48N Woodbridge, CT51 New Britain, CT52 Wallingford, CT58 Dearborn, MI59 Monroe, MI60 Taylor, MI61 CT Vocational-Technical, CT62 Southgate, MI66 Bristol, CT67 Lewiston, ME72 United Federation of Technicians, CT73 Auburn, ME74 Southington, CT78 Hartford Support Supervisors, CT79 Oklahoma City, OK81 Berkeley, CA82 Hartford Educational Support, CT83 Oakland, CA84 Calvert County, MD87 Bangor, ME91 Norwich, CT92 Cheshire, CT94 Torrington, CT97 Manchester, CT98 New Fairfield, CT100 St. Croix, VI101 St. Thomas, VI102 Queen Anne County, MD106 Thompson, CT109 PG County, MD111 East Hampton, CT113 Newtown, CT115 Putnam, CT116 Kent County, MD119 Exeter, NH120 Milford, CT121 Hamden, CT123 Coventry, CT125 Columbia, CT126 Easton, CT127 South Windsor, CT128 Branford, CT130 Region One, CT132 Nashua, NH134 San Diego City, CA134R San Diego City, CA Retirees135 Gilbert, CT136 Denver, CO137 San Diego Community Colleges, CA138 Chester Upland, PA139 Seattle, WA140 Summit, CO141 Portland, OR142 South Paris, MEIndividual RetireeSpeakerGuest/Non-MemberExhibitor/SponsorOther Your AFSA Local Number, use the dropdown to select your local, if you cannot find it, INDIVIDUAL RETIREE, SPEAKER, GUEST and OTHER are at the end of the dropdown list. Please Indicate your Delegate Status * Delegate Alternate Neither Employment Type * Certificated Classified Retired OtherOther Job Titile * Principal Assistant Principal Other School Based Administrator Central Office Administrator Speaker Guest Exhibitor/Sponsor OtherOther Gender * M F OtherOther Are you a Veteran * Yes (enter branch of service):Yes (enter branch of service): No Are you on Twitter? * Yes - this is my handle:Yes - this is my handle: No My Other Social Media Facebook Instagram Linkedin T-Shirt Size Requested - NOTE: These shirts are cut a bit on the small side so consider the next larger size! * Men's S Men's M Men's L Men's XL Men's 2XL Men's 3XL Women's S Women's M Women's L Women's XL Women's 2XL Women's 3XL Special Request (we will accommodate your request IF possible):Special Request (we will accommodate your request IF possible): Do you have any Dietary Restrictions? Vegetarian Other (we will accommodate your request IF possible):Other (we will accommodate your request IF possible): None Please indicate which sessions you plan to attend at the convention. You may select one session per time slot. To see the full program and session descriptions in a separate tab click HERE July 21st 6PM * Opening Reception Sponsored by CSA, AFSA Local 1 Will not attend July 22nd 10:30AM * Plenary Session: Caring for Yourself and Your Members: Supporting the Mental Health, Self-Care, and Wellness of School Leaders Retiree Session: Age Proofing Your Home Will not attend July 22nd 11:55AM * Culturally Responsive Leadership: “How to Bridge the Cultural Disconnect” Identifying Emerging School Leaders Get Your Life Back, Without Losing Your Job: Post-Pandemic Self-Care for Education Administrators Conversations with The Principals Trust Beyond the individual: how to create a supportive culture and organizational structure to promote self wellness in your school Focus on individual impact and personal/individual response Retiree Session - Mobilizing Retirees for Political Action Will not attend July 22nd 1PM * AFSA PAC Luncheon (Paid Event - $150 - payment instructions below) Will not attend To make your $150 payment for the PAC luncheon, you can pay online HERE or make out a check to AFSA PAC and mail to: AFSA-PAC, 815 16th St NW Ste 4125, Washington, DC, 20006. Your cancelled check will be your receipt. July 22nd 2:15PM * Plenary Session: Labor Lessons Learned from the Pandemic Retiree Session: Mental Wellness - Life Journey in Retirement Will not attend July 22nd 5PM (Optional Activities) * Mixology Intergenerational Dancing Movie Screening Will not attend July 23rd 9AM * Plenary Session; Lifting the Bar Intervention! Retiree Session: Mental Wellness- Ways to Release Stress, Anxiety, and Depression Will not attend July 23rd 11:30AM * Lifting the Bar- Intervention! Follow-Up Just Got Elected - Now What? Politics 1 on 1 - Conversations referencing ever evolving Political Hot Topics Identifying and Developing Emerging Union Leaders Federal Student Loans Simplified! Creating the Conditions to Promote Inclusive Excellence in Educational Spaces How to Build the School Leader Brand in Your Community Retiree Session – Financial Wellness Will not attend July 23rd 1PM * Luncheon Will not attend July 23rd 7PM * Concluding Banquet Will not attend Position your mouse cursor in the signature box below. Press and hold the left mouse button to draw your signature. Your Authorization Signature * signature keyboard Clear Date * **For complete convention program Click Here, convention schedule is subject to change without notice. If you are human, leave this field blank. Submit
