Classroom Registration Form

Apply early! One classroom visit by an engineer per form, please, but you may submit as many forms as you wish. For your convenience, this online form can be used easily for more than one request. The information you enter for one classroom visit request will remain in this form for subsequent requests during this online session, and can be edited. For each request, be sure to press the “send registration form” button after supplying information specific to that request.

    Note: If you have problems with this registration page, then click your browser’s “refresh” (or “reload”) button before filling in the blank spaces.
Teacher’s Name:
Day Phone (include area code):
Evening Phone (include area code):
Email:
School:
Address (include zip code):

Comments and presentation requests (topics that will complement your class curriculum):

* * * * * * * * * * * * * Details for One Classroom Visit By an Engineer * * * * * * * * * * * * *
Preferred day of week: (M, T, W, Th, F)
Best time period for an hour-long visit (9-11, 1-3, etc.)
Grade Level
Subject Taught
Number of Students

Alternatively, you may print and mail forms as soon as possible to:

 

  Marie Ciano
1202 Chesterton Court
Walnut Creek, CA 94596
(925) 280-3920 Ext 2856
Email: majdwj@astound.net




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Engineers