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Request to Open Registration Form
Chapter:
*
Date Submitted:
*
Dates the Workshop Will Be Held:
*
Name and Address of Location:
Address Where the Course Materials Are to Be Shipped:
*
Contact Name
*
Address 1
Address 2
Address 3
*
City
*
State/Province:
*
Postal Code:
*
E-mail Address
*
Phone Number:
Is this a business?
Yes
No
Workshop Instructor:
*
Name
*
E-mail Address
Telephone
STEP Coordinator:
*
Name
*
E-mail Address
*
Phone number
Name of Onsite Contact (If Different)
Onsite Contact's Phone Number (If Different)
Workshop Schedule
*
Day 1 Start Time
*
Day 1 End Time
*
Day 2 Start Time
*
Day 2 End Time
*
Day 3 Start Time
*
Day 3 End Time
Building Access:
*
Please describe in detail any instructions needed for students to get to the room for the workshop
Hotel near the workshop site you would recommend:
*
Name
*
Address
*
City
*
Telephone
Web Site Address
*
Proximity to workshop site
*
Local restaurants
*
Directions to the Workshop Site
*
Parking (location, cost, validation)