Quantum Learning 2017
Registration Form

Program:
Excellence in Teaching: Design and Delivery

Date(s):
June 22 - 23, 2017

Time:
8:00 am – 4:00 pm

Location:
Oak Brook Park District, 1450 Forest Gate Road, Oak Brook, IL 60523
Map

Contact:
Shari Murphy. at smurphy@qln.com

Fees:
$250 Early Bird Special by Thursday, June 01, 2017
$275 per person after Thursday, June 01, 2017

Discount code:

Billing/Registration Contact
First Name:  
Last Name:  
Position:  
School/District/Organization Name:  
Address:  
Address Line 2:
City:  
State:
Zip:    
Country:  
Email:    
Phone:  

Participant Information Please provide summer contact information. (All fields required.)
First Name Last Name Position Org. Name Email Phone
(1)       



Payment    

  Payment Amount: $250.00        
  Name on card:    
  Card number:
  Expiration date:  
  Security Code:
(3-digit)
   

  Billing Address
Zip Code:
   
  Special Instructions:
 

Note: Fees include program materials. These fill up quickly, and seats are available on a first-come, first-served basis. Fee is non-refundable if cancellation is made within 10 days of the program. Substitutes are permitted with prior approval from QLN. Please send substitution request to Quantum Learning Education at contact@quantumlearning.com. If the minimum number of registrations is not met this workshop may result in a postponement or cancellation, and refund or credit will apply. Payments will not be processed immediately for this reason, but will be processed within two weeks of the program.

For questions regarding registration please contact Quantum Learning Education at contact@quantumlearning.com.




            Confirmation will be sent to the email(s) provided above.