GEMS Leader's Professional Development Application
Name ___________________________________________________________________________
(as you would like it to appear on your name tag)
Partner's Name (if applicable)____________________________________________________
Institution/Work Address_______________________________________________________________
City ___________________ State ____ Zip _________ Work Phone ( _____)
_____________
e-mail _____________________________________
Position _______________________________________ Grade Level Involvement
_________
Home address _______________________________________________________________
City ___________________ State ____ Zip _________ Work Phone ( _____)
_____________
Please check the appropriate session(s).
Leader's Professional Development:
__ July 19, 2004, Grades 5—8.
__ July 20, 2004, Grades 3—6.
__ July 21, 2004, Grades 2—4.
__ July 27, 2004, Grades 1—5, a special day of math activities
with Jaine Kopp.
We encourage teams of people from the same community to take advantage
of the discounted team rates. Team members must each fill out an application
and return them together in the same envelope. Visa or MasterCard accepted.
Make check/purchase order to: Regents of the University
of California
- Leader's Professional Development Fees:
- $185 per person one day; $295 per person two days;
$375 per person for three days. Fee includes 3 GEMS Teacher's Guides
of your choice and 1 GEMS handbook for each day of participation,
and lunch each day.
Accommodations and Transportation
- Mail completed application and payment to:
- University of California, Berkeley
GEMS Professional Development
Lawrence Hall of Science # 5200
Berkeley, CA 94720-5200
For credit card payments
Cardholder Name:_____________________________________
Card Number:_____________________________________
Expiration Date:_____________________________________
Card Type (Visa or MasterCard):_____________________________________
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