Vernier On-Site Workshop Application

To arrange a Vernier on-site workshop, please fill out the following application. If an on-site workshop does not fit your needs, please go to our workshop web page for a listing of other options.

- Indicates required field

	Name:
	School Information
	School Name:
	School Address Line 1:
	School Address Line 2:
	School City:
	School State/Country:
	School Zip/Postal Code:
	School Phone:
	If you are requesting a workshop during summer break, please provide a home phone number we can reach you. Home Phone:
	Fax:
	E-Mail:
	Would you like to be added to our e-mail list?    Yes No (No more than five e-mails a year. Our privacy policy).
	When would you like to hold the workshop? Provide at least 2 dates, at least 6 weeks in advance. Training limited to one day.
	First Choice:
	Second Choice:
	Other days, options or requests:
	Please indicate your position position Teacher Technology Specialist Dept. Chair Principal Other
	How many will attend the workshop (Maximum of 30)?
	What grade levels do the participants teach?
	What are the experience levels of the teachers with Vernier products? (Check all that apply)
	Beginner Intermediate Advanced
	What will you be collecting data with? (Select all that apply)
	Windows Computer Macintosh Computer TI graphing calculator Palm
	What interface(s) are you using?
	Vernier LabPro Vernier LabQuest TI CBL2 Universal Lab Interface Serial Box Interface Original CBL
	How many of the following Vernier sensors do you have?
	Accelerometer Flow Rate Sensor pH Sensor Barometer Force Sensor Pressure Sensor CO2 Gas Sensor Gas Pressure Sensor Radiation Monitor Colorimeter Instrumentation Amplifier Relative Humidity Sensor Conductivity Probe Ion-Selective Electrodes Respiration Monitor Belt Current & Voltage Light Sensor Sound Level Meter Digital Control Unit Magnetic Field Sensor Rotary Motion Sensor Dissolved Oxygen Probe Microphone Temperature Probe EKG Sensor Motion Detector Turbidity Sensor Exercise Heart Rate Monitor O2 Gas Sensor Vernier Photogate
	Which of the following lab manuals do you have? Biology with Computers Chemistry with Computers Physics with Computers Water Quality with Computers Middle School Science w/ Computers Physical Science with Computers Real-World Math with Computers Biology with CBL Physics with CBL Physical Science with CBL Biology with Calculators Chemistry with Calculators Physics with Calculators Water Quality with Calculators Middle School Science with Calculators Physical Science with Calculators Real-World Math with CBL 2 and LabPro Chemistry with CBL Water Quality with CBL Nuclear Radiation with Computers       and Calculators Science with Handhelds
	What Vernier software are you using?
	Logger Pro Graphical Analysis Spectro Pro DataMate
	Which subjects do you want to cover in the workshop? (Check all that apply)
	Biology Chemistry Earth Science / Geology Environmental Science General Science Integrated Science Life Science Math Physical Science Physics Water Quality
	Billing Information
	The $1200 U.S. funds workshop fee will be billed shortly after the workshop.
	Bill to:
	Address Line 1:
	Address Line 2:
	City:
	State:
	Zip/Postal Code:
	PO number, if applicable:

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