ATTN: Dave Bartlett -------------------------------------------------------FAX: 812-856-8232

Registration Form
Curriculum Integration Workshop June 19-21, 2001
$125/participant

Name:_______________________________________________________________

Position/Title:__________________________________________________________

School:_______________________________________________________________

Email Address:_________________________________________________________

Phone:__________________________ Fax:__________________________________

School Address: ________________________________________________________

_____________________________________________________________________

Home Address: _________________________________________________________

_____________________________________________________________________

Topic Project Ideas: _____________________________________________________

_____________________________________________________________________

_____________________________________________________________________

I am interested in taking this workshop for graduate university credit

Technical Training checklist

I need training on the Vision Athena equipment

I need training on teletechniques for instruction

Web Publishing Access and Resources

Computer Software Applications that support my project design

Name types of programs (ex: presentation software like Power Point):

______________________________________________________________________

Dietary, special needs, or considerations not covered above:

______________________________________________________________________

______________________________________________________________________