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Workshop and Program Registration
Teacher Workshop Application

or download it as a PDF (77K).


Participant Name:		 _____________________________________

School: 		_____________________________________

District:		 _____________________________________

School Address:		 _____________________________________

City, State, Zip:		 _____________________________________


Home Address:		 _____________________________________

City, State, Zip:		 _____________________________________

Home Phone:		 _____________________________________

Work Phone:		 _____________________________________

Fax:		 _____________________________________

E-mail:		 _____________________________________

Check the Teacher Workshop(s) you would like to attend:
Fees include all workshop materials. Graduate credit is available through Ashland University for an additional fee. Register for all three sessions for $115!
____ Inquiry into GROSS Science Teacher Workshop
Session 1: The Human Body | February 25, 2010 (4:30pm-9:00pm)		 $45
____ Inquiry into GROSS Science Teacher Workshop
Session 2: Exercise Physiology | March 11, 2010 (4:30pm-9:00pm)		 $45
____ Inquiry into GROSS Science Teacher Workshop
Session 3: Nutrition | March 25, 2010 (4:30pm-9:00pm)		 $45

Payment due:
$___________

Please check your form of payment and fill in the details:

____
Check #
 _____________________________________
____
PO # (attach PO copy)
 _____________________________________
____
Visa #
 _____________________________________
____
Mastercard #
 _____________________________________
____
Discover #
 _____________________________________
____
 Expiration Date _____________________________________
____
Name on card
 _____________________________________

Cancellation Policy
To receive a full refund, cancellations must be made before the registration deadline. Cancellations made after the registration deadline may be applied to another COSI Teacher Professional Development programs or participants will receive their reimbursement in COSI Bucks.

Release Form:
COSI "has / does not have" (please circle one) permission to photograph me during the hours of the COSI Teacher Program for promotional purposes, including, but not limited to, press releases, COSI promotional material, etc.  Please initial _______

Participant Signature: ________________________ Date: _________________		   Watch an Autopsy


Return your application by:

MAIL
COSI Teacher Programs
attn: Corey Markham
333 West Broad St
Columbus, OH 43215

EMAIL
Corey Markham
cmarkham@mail.cosi.org

FAX
614.629.3226
attn: Teacher Programs
 
 
Contact COSI Faculty or Ask Questions:
Teacher Professional Development
614.228.2674
Email Teacher Programs
Register for a Teacher Workshop
    COSI hosts many opportunities to help
  educators teach science.  Teachers can
  enhance inquiry based learning to
  improve science and math education,
  and earn college credit toward their
  Masters or Masters Plus degrees.