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

North Central Math/Science Education Collaborative
108 Becht Hall, Clarion University
Clarion, PA 16214

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