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Registration Form

2008 Duke - NC PLTW Teacher and Counselor Conference
Wednesday, February 20th, 2008

Raceworld USA
20310 Chartwell Center Drive
Cornelius, NC 28031

If you have questions about conference registration, please call Nancy Shaw at 919-622-5379.

To register for this event, please fill out the form below.
Required Fields are marked with a *


 
Title
First Name *
Last Name *
Your School Position *

 
School Name *
School Principal *
School District Name *
School Street Address1 *
School Street Address2
PO Box
City *
State *
Zip *

 
Work Phone *
(including area code)
School Fax Number
Email Address *
 
Billing Contact Name *
Billing Contact Phone Number & Extension *
Billing Contact Email Address *

 
Duke University Tax ID Number: 56-0532129
Checks should be made to: Duke University

Mailing Address:
Duke University, Pratt School of Engineering
Department of Electrical and Computer Engineering
130 Hudson Hall
# 90291
Durham, NC 27708

Is this your first Counselor Conference? *
Yes
No

How will you submit $20 registration fee? *
Payment Order #:
(If Applicable)
Pre-Engineering Program