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):_____________________________________

Lawrence Hall of Science    © 2005 UC Regents. All rights reserved.    Contact GEMS    Updated December 17, 2020