We customize all of our training to our audience so we need a little bit of information about you and your educational institution to enable us to do this. Every WomenTech Workshop registrant is required to fill out a short on-line questionnaire. Click here for the questionnaire.

Mail this form to: National IWITTS, 1150 Ballena Blvd, Suite 102, Alameda, CA 94501-3682 or fax to (510) 749-0500. Contact IWITTS via e-mail or call (510) 749-0200.

Each participant will receive our best practices WomenTech Training Manual (only available through this workshop), and the WomenTech Educators Tool Kit, a $255 value. The WomenTech Educators Tool Kit includes our Video and Video Facilitator's Guide, PowerPoint Disk, Trainer's Workshop Guide, Bibliography, and Participant's Workbooks.

Pricing (please mark those that apply):

_____ $425 Early Bird (registration received by Sept 2)

_____ $500 Regular Price (registration received after Sept 3)

_____ $575 Late registration (registration received after Sept 22) Late Fee Waived

Schools registering 3 or more participants at once receive a group discount of $100 off per participant.

Method of Payment (All registrants must be prepaid or include a P.O. Number to confirm their registration)

______Check

National IWITTS Federal ID # is 522059171. Make check payable to National Institute for Women in Trades, Technology & Science (National IWITTS)

______Purchase Order No.__________________

______Credit Card. PLEASE COMPLETE "CREDIT CARD BILLING INFORMATION" SECTION AT THE BOTTOM OF THE FORM

Training Participant Information

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Name

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Job Title

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Organization

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Address

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City/State/Zip

________________________________________________________
E-mail

________________________________________________________
Phone

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Fax

Billing Information

________________________________________________________
Name

________________________________________________________
Organization

________________________________________________________
Address

________________________________________________________
City/State/Zip

________________________________________________________
E-mail

________________________________________________________
Phone

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Fax

Credit Card Billing Information

_____ Mastercard or _____Visa

___________________________ Credit Card Number

_____________ Expiration Date

________________________________________________________
Signature of Cardholder

________________________________________________________
Is this a company card? If yes, please indicate name of company on card

________________________________________________________
Address (your billing address must match the address on your credit card
statement or your credit card may be declined)

________________________________________________________
City/State/Zip

Phone ___________________________________________________

Mail this form to:
National IWITTS, 1150 Ballena Blvd, Suite 102
Alameda, CA 94501-3682
or fax to (510) 749-0500.
Contact IWITTS via e-mail or call (510) 749-0200.