Event Registration

*First Name:
*Last Name:
*Address:
*City:
*State:
*Zip
*County
*Phone
*Email

Please Check One:

If you have selected Other please enter your organization type below:

Other:

If you have selected Center or Preschool please enter your organization name below:

Center/Preschool Name

Special Dietary Needs:
(If you are in need of any special dietary needs, please list them in the box below.)
Paper Certificate
 I would like a paper certificate at the conference. ($5/per certificate)


Develop ID Number
If you have Develop ID Number, type it in the box below.
Information about how to receive a Develop ID Number can be found at this link: http://www.developtoolmn.org)

Will you be attending the Keynote?
Yes
No


Choose an event from the drop down you wish to register for.


Payment Options

Credit Card or PayPal (no account required)
Check
Credit Card by Phone
PO Number


Please Check One:

I am a member of the Milestones/Child Care Choices Food Program

If you have selected Yes please enter your Milestones/Child Care Choices Provider ID number below:

Provider ID:   

You MUST be a member of Milestones/Child Care Choices food program in order to receive this discount.

About
Milestones
-Our History
-Program Staff
-Contact
Career
Opportunities
-With Milestones
-With Childcare Centers
Contact us
Toll Free: 800.288.8549
Telephone: 320.251.5081
Fax: 320.654.8650
Mail: PO Box 548
Waite Park, MN 56387
E-mail: info@milestonesmn.org