Mechatronics Workshop Registration Form

Mechatronics with Instrumentation & Controls - Integrating Instrumentation and Process Control into the STEM Classroom

Date: July 14-16
Time: 8:30 a.m. - 4:30 p.m.
Location: CCC - Columbus
Building: North Education Center
Room: 911
Cost: Free
Stipend: $110 daily
Section: 20/RE _______________

Register by July 6, 2020

Complete registration form. (Fields with an asterisk* are required fields.)
Select submit. (If a summary box does not appear, complete the fields in red.)
Click OK on summary box to submit your registration.

Last Name*

First Name*

Middle Initial

Maiden/Former Name

Mailing Address (PO Box/Street)*

City*

State*

Zip Code*

Date of Birth*

Work Phone

Home or Cell Phone*

Email*

Do you receive payment from CCC for other work? (Teach at CCC, learning center manager, teach a dual-credit course at the high school, etc.)* Yes No

If you receive payment from CCC for other work, are you paid monthly or bi-weekly?* Paid Monthly Paid Bi-Weekly I do not receive payment from CCC.

Your CCC ID (if applicable)

High School you work at*

Your teaching area at the high school.*