ALAHASP Workshop/Event Registration and Data

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First Name:(*)

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Last Name: (*)

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City:(*)

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State:(*)

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Preferred Phone Number:

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Cell Phone Number:

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E-mail: (*)

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System/Organization:(*)

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School/Department:(*)

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TOTAL Number of Students you teach or serve:(*)

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TOTAL Number of Science Students you teach or serve:(*)

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Are you currently teaching out-of-field?(*)

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Certificate Level:(*)

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Highest Academic Degree:(*)

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Grade Level(s) of Students You Teach, Counsel, or Serve:(*)

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Number of years of full-time professional teaching/administrative experience:(*)

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Please mark only one:(*)

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First name you would like to be printed on your workshop badge:(*)

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Do you use hands-on science kits in your classroom?(*)

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Does ALAHASP have your permission to use for reproduction any photos taken during this event in which you appear?(*)

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Alternative Contact Information

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Kindergarten Science


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Please enter the following characters:(*)

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