Please submit this registration form with payment by deadline of appropriate workshop to:

North Central Math/Science Education Collaborative
232 Ralston Hall, Clarion University
Clarion, PA 16214

Name:		_____________________________________
E-mail:		_____________________________________
School District:		_____________________________________
School Address:		_____________________________________ _____________________________________
Phone:		Work: ____________________ and/or Home: ____________________
Workshop Name:		_____________________________________
Date(s) Attending:		_____________________________________

To ensure a place is held for you until payment is received, you may call 814.393.1612 or e-mail mathsci@clarion.edu. No places will be held after registration deadline.