ALAHASP Workshop/Event Registration and Data

* denotes Required Fields

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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Introduction to The Private Eye, Part 1
UAB Center for Community OutReach Development, 5th Floor.
By invitation only; Additional Details following registration



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Introduction to The Private Eye, Part 2
UAB Center for Community OutReach Development, 5th Floor
By invitation only (Previously attended Part 1); Additional Details following registration


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