Are you registering with a group or as an individual?* group individual Choose the registration that best fits your group size and timing.*Group size must be three or more to qualify."Super Early Bird" Group Registration (by October 7, 2021) $549.00 each"Early-Bird Registration" (October 8, 2021 - January 15, 2022) $599.00 eachStandard Registration (January 16 - May 15 2022) $649.00 eachLate Registration (after May 15, 2022) $699.00 eachChoose the registration that fits for you.*"Super Early-Bird" Registration (by October 7, 2021) $599.00“Early-Bird” Registration (October 8, 2021 – January 15, 2022) $649.00Standard Registration (January 16 – May 15, 2022) $699.00Late Registration (after May 15, 2022) $749.00Group nameMake sure everyone in your group uses this name. In order to get the group rate, at least two other people need to use the same group name. Includes opening night dinner, an in-park Disney special event, 3 days of breakfast and lunch, all conference sessions, and discounted hotel rates and park tickets available to attendees Add a Virtual Registration ($149 by January 15th 2022, then $199)Provides remote/virtual access to all general sessions for colleagues of attendees unable to join in person. Available to registered groups of 3 or more attendees / must be linked to in-person group registrations. yes no Name* First Last Email* Phone Number*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code I am a...*Please select the role that best fits your primary position: Teacher Parent / Caregiver School Administrator District Administrator Counselor/Psychologist Other School or organization name* Do you have any food allergies or restrictions?*This information will be sent to Disney Culinary Services to meet your dietary needs. (If none, please enter "None.")Coupon Total $0.00 Payment Plan: Super Early-Bird rates require either a completed purchase order by October 7, 2021—or, if paying by check or credit card, an initial deposit of 30% must be made by October 7, 2021; a second (30%) deposit by Jan. 15, 2022; and a final payment (40%) by May 15, 2022. Early-Bird rates rates require either a completed purchase order by January 15, 2022—or, if paying by check or credit card, an initial deposit of 40% must be made by Jan. 15, 2022; and a final payment (60%) must be made by May 15, 2022. Standard registration registration rates require a completed purchase order or a credit card transaction for the full amount by May 15, 2022. If not paid in full at registration, invoices will be sent for payment. For check or credit card registrations, installment payments must be made according to the above timeline in order to retain the “super early-bird” or “early-bird” discounted rates. For summit attendance, all registrations require full payment no later than May 25, 2022 Cancellation Requests Cancellation requests must be submitted to Pegasus Springs Education Collective by email no later than May 15, 2022. Registrants who are unable to attend may either designate a non-registered person to attend in their place or request a refund. (A $35 processing fee will be charged for each registration refund.) After May 15, 2022, registrants may only transfer their registration to a non-registered person to attend the event in their place, with registration confirmation or written authorization from the original registrant. No refunds will be issued after May 15, 2022. Permissions By registering and participating in the event, you understand that at this event or related activities, you and/or your child/student (if participating) may be photographed. As a participant in the event or activity, you agree to allow your and/or your child’s/student’s photo, video, or film likeness to be used for any legitimate purpose by the event holders, producers, sponsors, organizers, and assigns. Pegasus Springs Education Collective is a nonprofit organization. As part of the resort agreement for this event, Pegasus Springs Education Collective receives an $11 rebate for each room night at the hotel occupied and paid for by event coordinators and attendees at the group room rates during the dates of the designated room block. All funding from any rebate that is generated is used to offset the other expenses associated with offering this specific event to attendees. By participating in the event, you consent for you and/or your child/student to receive medical treatment that may be deemed advisable in an emergency or in the event of injury, accident, and/or illness during this activity or event. You are aware that there is no health insurance coverage associated with this event or activities and that participants should carry their own health insurance. If medical treatment is needed as a result of participation in this activity or event, travel to and from the activity or event (including air travel), or any activity incidental to this event, you agree to be financially responsible for any costs incurred as a result of such treatment. By registering, you certify that you are voluntarily participating in this event and assume all risks for participation. You indemnify and hold harmless Pegasus Springs Education Collective, its directors, partner organizations, event coordinators, and volunteers from any and all liabilities or claims as a result of participating in this activity or event. (For student programs, parents/ guardians/ chaperones will also be asked to sign a release and permission form for their child’s/student’s participation.) 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