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 upload size: 314.57MB 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 Local 1 New York, NY 1C New York, NY Retirees 2 Chicago, IL 3 San Francisco, CA 3E San Francisco, CA Retirees 4 Washington, DC 6 Boston, MA 8 Yonkers, NY 8C Yonkers, NY Retirees 9 Woodhaven, MI 10 Buffalo, NY 11 Wyandotte, MI 13 Bloomfield, CT 18 New Haven, CT 20 Newark, NJ 22 Hartford, CT 25 Baltimore, MD 27 Shelton, CT 28 Detroit, MI 36 Howard County, MD 42 East Hartford, CT 42A Griswald, CT 42F Cromwell, CT 42H North Stonington, CT 42K East Haddam, CT 42N Watertown, CT 44 St. Louis, MO 44C St. Louis, MO Retirees 48C Region 16, CT 48L Madison, CT 48N Woodbridge, CT 51 New Britain, CT 52 Wallingford, CT 58 Dearborn, MI 59 Monroe, MI 60 Taylor, MI 61 CT Vocational-Technical, CT 62 Southgate, MI 66 Bristol, CT 67 Lewiston, ME 72 United Federation of Technicians, CT 73 Auburn, ME 74 Southington, CT 78 Hartford Support Supervisors, CT 79 Oklahoma City, OK 81 Berkeley, CA 82 Hartford Educational Support, CT 83 Oakland, CA 84 Calvert County, MD 87 Bangor, ME 91 Norwich, CT 92 Cheshire, CT 94 Torrington, CT 97 Manchester, CT 98 New Fairfield, CT 100 St. Croix, VI 101 St. Thomas, VI 102 Queen Anne County, MD 106 Thompson, CT 109 PG County, MD 111 East Hampton, CT 113 Newtown, CT 115 Putnam, CT 116 Kent County, MD 119 Exeter, NH 120 Milford, CT 121 Hamden, CT 123 Coventry, CT 125 Columbia, CT 126 Easton, CT 127 South Windsor, CT 128 Branford, CT 130 Region One, CT 132 Nashua, NH 134 San Diego City, CA 134R San Diego City, CA Retirees 135 Gilbert, CT 136 Denver, CO 137 San Diego Community Colleges, CA 138 Chester Upland, PA 139 Seattle, WA 140 Summit, CO 141 Portland, OR 142 South Paris, ME Individual Retiree Speaker Guest/Non-Member Exhibitor/Sponsor Other 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 * 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
