CNS Institute for Physics Teachers

Sign up for the CIPT Fall 04 Workshop

The workshop will be limited to the first 40 teachers and 40 high school students. A $20 refundable application fee is required by October 7th . A $50 refundable fee is required for hotel reservations by September 20th. Please make checks payable to Cornell University and mail to: Tali Blank, CIPT, 632 Clark Hall, Ithaca, NY 14850. Checks will be returned to you at registration.

The most important information is marked with an asterisk.

* Name:

Home telephone:

Work telephone:

* Email:

Home address:

City:

State:

Zip:

* High school/institution where employed:

* School/institution address:

* City:

* State:

* Zip:

Yes, I have enclosed the $20 check for application fee.

Yes, I need housing for October 15th . I have enclosed the $50 fee for hotel reservation. Housing will be limited to the first 14 registered teachers.

You are invited to bring your students with you (up to two). We will have a special program to introduce them to the physics and engineering in higher education.

Unfortunately, we can’t offer housing for students.

Student first name: _________________ Last name:______________________

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