REGISTRATION FORM
3-day Teacher Training Workshop:

Transforming High School Classrooms into
Smaller Learning Communities and
Improving Student Achievement
Thurs.- Sat., January 19-21, 2006

Name:________________________________________________________________

Title:_________________________________________________________________

Organization or School :_________________________________________________

Business address: _____________________________________________________

City:________________ State:_____  Zip:_______ Tel:(_____)__________________

FAX:(___ )_________________________

Email:_____________________________

Home address:_________________________________________________________

City:________________State:_____  Zip: _______Tel:(______)__________________

FAX:(____)_____________________

Email:_____________________________

If you are a teacher, what subject do you teach? _____________________________

What grade levels do you teach? __________________________________________

Training session will be held from 8a.m. to 4p.m. on Thurs. and Fri., January 19 & 20, and from 8a.m. to 2:00 pm. Sat., January 21.

DoubleTree Hotel, 445 S. Alvernon Way, Tucson, AZ 85711
(520-881-4200) Room rate: $126.00 per day.
To get this room rate, you must make room reservations by Sept. 15, 2005.  Be sure to let the hotel know that you are attending the Educational ReadSources Teacher Training.

Please complete and mail or fax (520-326-0953) Registration Form to Educational ReadSources by November 15, 2005. 

Please Note: Registration fee of $800 payable to Educational ReadSources, must be prepaid by January 19, 2006.

Purchase Orders must be received by December 1. Please send to:

Educational ReadSources
P.O. Box 43814
Tucson, AZ 85733-3814

(520-326-0953 – Tel & Fax)
email: edreadsrcs@aol.com