Mechatronics Workshop Registration Form

Registration Instructions:

Select the workshop you wish to attend.
Complete registration form. (Fields with an * are required fields.)
Select submit. (If "Thank you for registering" message does not appear, complete the fields in red.)

SELECT THE WORKSHOP YOU PLAN TO ATTEND. Mechatronics Workshop for High School Counselors and Administrators - June 11 (Kearney) 9:00 am - 4:00 pm - 18/RE INDT 7023 CK101 Mechatronics Workshop for High School Counselors and Administrators - June 13 (Columbus) 9:00 am - 4:00 pm - 18/RE INDT 7023 CC101 Mechatronics Workshop for High School Teachers - June 18-20 (Columbus) 8:30 am - 4:30 pm - 18/RE INDT 7022 CC101

Last Name*

First Name*

Middle Initial

Maiden/Former Name

Mailing Address (PO Box/Street)*

City*

State*

Zip Code*

Social Security Number*

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.*

Educational Opportunities

Mechatronics Workshop Registration Form

Registration Instructions: