Teacher Workshops
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Tools for Teaching
Workshop Registration Form

Please fill out all fields and print.
$350 per person (price in U.S. dollars)

Space is limited. Make phone reservations before you start your paperwork.
(831) 425-8222

This is not an electronic form. The information you provide here will not be sent anywhere but your printer.

Personal Information
First Name
 Last Name
Home Address
City
State
 Zip Code
 Country
Home Phone
 email
District
 School Name
Workshop Location

Billing Information:
(If paying by personal check, please have it accompany this form)

Purchase Order #

For Credit Card Purchases:
Visa Mastercard Card Number
Exp. Date
Authorized Amount
Name on Card
_________________________________
Signature

mail to:
Fredric H. Jones and Associates, Inc.
103 Quarry Lane
Santa Cruz, CA 95060-2052

phone (831) 425-8222 / fax (831) 426-8222