| You must register for all workshops. Please fill out this form listing one name and one workshop title per line. You may pay by check or credit card. Schools registering several teachers may pay with a purchase requisition. Questions? Call (630) 840-3092. |
| School or Educator Name____________________________________________ |
| Address (Home or School) _____________________________________________ |
| City ______________________________________ State __________ Zip_____________ |
| Home Phone____________________ Business Phone _______________________ |
| Educator's Name | Workshop Title | Date/Time | Grade Level | Fee |
|---|---|---|---|---|
| Total: $ | ||||
| Payment: | Please make checks payable to Fermilab. |
| Credit Card # (Mastercard or Visa only) _______________________ | |
| Expiration date_______ | |
| Signature______________________________________ | |
| Mail payment and registration form to: |
| Fermilab Education Office |
| P.O. Box 500, MS 777 |
| Batavia, IL 60510 |
| We refund all fees if we cancel a workshop. You will not be charged, if you cancel your registration one week prior to the workshop. You will receive written confirmation when we have your registration and payment. |