1 Start 2 Complete Please fill out this form and we will email you after the event to pay for your registration. Note: you will not be able to claim credit until we receive your payment or purchase order request. The staff at BU SHIELD will be in touch. Amount Due * Date of the Program * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 Full name (First and Last Name) * School District * Phone Number * Confirm or provide email address * Leave this field blank
