BILL ATWOOD

SUMMER 2010

WORKSHOP REGISTRATION FORM

To register online for Bill Atwood's summer 2010 workshops, please complete and submit the form below. To protect your security, we do not request credit card information online. Upon submission of your registration form, please contact us via phone at 800-932-4477 to provide the information we need to process your credit card payment and complete your registration.

1. Which workshop(s) do you wish to attend?

August 9 & 10: EDPM564 Improving Open Responses in Math (Grades 3-10) Trinity Catholic Academy, Brockton, MA

August 16 & 17: EDPM 575 Convince Me with a Story (Grades 2-8) Trinity Catholic Academy, Brockton, MA

August 18 & 19: EDPM 575 Convince Me with a Story (Grades 2-8) Morningside Community School, Pittsfield, MA

August 23 & 24: EDPM 564 Improving Open Responses in Math (Grades 3-10) Morningside Community School, Pittsfield, MA

2. How did you learn about the workshop?

Website Workshop Mailer Email Other

3. How do you wish to pay the registration fee?

PO Credit Card ** Check

** For security reasons, please call 1-800-932-4477 with your credit card information at your earliest convenience.

4. If you will be using a Purchase Order, what's the PO number?

PO #

5. Please list the names of all those being registered for the workshop:

6. Billing Contact: * REQUIRED

* Name
* E-mail
* Phone
Fax
School
* Street/PO Box
* City
* State
* Zip

7. Registration & Confirmation Contact: (if different from billing)

Name
E-mail
Phone
Fax
School
Street/PO Box
City
State
Zip

8. Enter any additional comments in the space provided below:

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320 Main Street, PO Box 957, West Newbury, MA 01985

TEL 800-932-4477 FAX 978-363-2212 EMAIL info@collinsed.com