Lawrence Hall of Science University of California, Berkeley

Parent Partners Leader's Workshop 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 ( ____ ) _____________

Position _____________________________________________

Home address _________________________________________________________________________

City ________________________ State ______ Zip __________ Home Phone ( ____ ) _____________

Please check the appropriate workshop.

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 (please include: Cardholder's Name, Card Number, Expiration Date).

Make check/purchase order to: Regents of the University of California

Parent Partners Workshop: Wednesday, July 23, 2020

Parent Partners Leader's Workshop Fees:

$110 per person or $85 per person for teams of two or more.
Fee includes continental breakfast, lunch, and a copy of Parent Partners.

Mail application and payment to:

University of California, Berkeley
GEMS Workshops
Lawrence Hall of Science # 5200
Berkeley, CA 94720-5200