Â
 Summer Workshops for Elementary Teachers
MSOE – Milwaukee, WI
Course Offerings: June 25-26, 2013 July 30-31, 2013 August 13-14, 2013
Â
Registration Form for Engineering is Elementary Workshop
Date Attending Date Attending EiE - June 25 & 26, 2013 EiE - July 30 & 31, 2013 EiE - August 13 & 14, 2013
Your Title Select One Teacher Administrator Other
* Your First Name
* Your Last Name
* Your School Email Address
* Your Home Email Address
* Best Contact Phone No
* School Name
Billing Contact
* Billing Contact Email
* School District Name
* School District Address
* School District City
* School District State
AL
AK
AK
AZ
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
DC
WI
WV
WY
* School District Zip
Payment Arrangements for $350 Tuition Select Payment Method Check will be sent to MSOE Call MSOE with Credit Card
Hotel Accomodations
Hyatt Regency 333 W. Kilbourn Milwaukee , WI
Will you need a hotel room? Select One Yes No
Single or Double Occupancy Select One Single Occupancy ($140 per night) Double Occupancy ($85 per person)
If you select double occupancy please specify their name below:
Â
Roommate First Name
Roommate Last Name
Do you have any dietary restrictions? If so, please indicate.
Any other special requirements? If so, please indicate.
Validation Code
(please enter the numbers in the image below)