Modeling Workshop Teacher Registration Form

Registration Form for
Modeling Chemistry
June 17-28, 2019, 7:30 AM-2:00 PM, Fee: $325
Wheaton Warrenville South High School

All Places in Session: "Modeling Chemistry" Filled.

If you register, you will be put on a waiting list and receive an email if a place opens up.

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Teacher's Information for Modeling Workshops

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First Name: *
Last Name: *
Home Phone: *
Email Address: *
IEIN (Illinois Educator Identification Number):
Address1: *
City: *
State: *
Zip Code: *

Teacher's School Information

Currently teaching: * If yes, fill in the rest of this section. If no, skip it.

School Name *
Your School Email: *
Your School Phone* *
Grade Levels Currently Teaching: *
Address1 *
School City: *
School State*
School Zip: *

Confirm Registration Information

Please review all your information and set Registration Information Confirmed to "Yes" to indicate you are ready to submit the registration. Then click Submit Registration
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