SPRING 2010 ONLINE WORKSHOP REGISTRATION FORM

To register online for one of our spring 2010 workshops, please complete and submit the form below. To protect your security, we do not request credit card information online. Upon submission of your registration form, please contact us via phone at 800-932-4477 to provide the information we need to process your credit card payment and complete your registration.

1. Which workshop(s) do you wish to attend?

April 6: Four Essential Writing Assignments (Grades 5-12)

April 7: Seven Sentence Building Activities (Grades 2-10)

April 8: Writing & Thinking Across the Curriculum (Grades 1-5)

2. How did you learn about the workshop?

Website Workshop Mailer Email Other

3. How do you wish to pay the registration fee?

PO Credit Card ** Check

** For security reasons, please call 1-800-932-4477 with your credit card information at your earliest convenience.

4. If you will be using a Purchase Order, what's the PO number?

PO #

5. A group discount is available for groups of 5 or more. Will 5 or more people be attending from your school or district?

Yes No Not Sure

Please list the names of all those being registered for the workshop:

6. Billing Contact: * REQUIRED

* Name
* E-mail
* Phone
Fax
School
* Street/PO Box
* City
* State
* Zip

7. Registration & Confirmation Contact: (if different from billing)

Name
E-mail
Phone
Fax
School
Street/PO Box
City
State
Zip

8. Enter any additional comments in the space provided below:

Collins Education Associates

320 Main Street

PO Box 957

West Newbury, MA 01985

Phone (978) 363.1188

Toll Free (800) 932.4477

Fax (978) 363.2212

Email info@collinsed.com

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No portion of the Collins Writing Program^sm or products of Collins Education Associates LLC may be copied without permission.

320 Main Street, PO Box 957, West Newbury, MA 01985

TEL 800-932-4477 FAX 978-363-2212 EMAIL info@collinsed.com