BBDiscovery Workshop Registration Form

           

Teacher Contact Information

Please print legibly.

Workshop Title and date(s):_______________________________

Name:________________________________________________________

SSN: _____________________ (for payment of stipends, will be kept confidential)

School:_______________________________________________________

Email Address: _______________________________________________

How often do you check email ?______________________________________

School mailing address:_________________________________________

School phone number:__________________________________________

Home Address:____________________________________________(needed to send stipends)

Other phone number:__________________________________________

Subject(s) & grade level(s) taught:________________________________________________

Planning period:______________Times: ______________ Class length_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________