Seminar Information Request Form Home Seminar Information Request Form Please complete this form to receive information on Brookes On Location seminars. (You can also call toll-free 1-800-638-3775 or 410-337-9580; please review the questions on this form before calling.) EmailThis field is for validation purposes and should be left unchanged.1. Professional Development InterestsWhich seminar would you like to be contacted about?*Do you already use the tool(s) that correspond(s) to this seminar topic?* Yes No How did you hear about this seminar?*Please selectIn a mailingOn the webIn an ad in a bookIn materials included in my last package from BrookesAt a conferenceIt was recommended by a friend/colleagueFrom a customer service representiative at Brookes2. Contact InformationFirst name*Last name*Title*School/Organization*Address*Country*United StatesCanadaCity*State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificProvince*AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonZip/postal code*Phone*Fax*Email address* How do you prefer to receive a reply?* Email Phone Fax Type of organization*Ex: Child Care, Preschool, Head Start, College/University, etc.3. Seminar InformationTelling us more about your needs will help us give you a more detailed reply. It's OK if you're not sure yet!Approximately how many people would you like to include?* Not sure 1-10 11-25 26-50 51-100 More than 100 When would you like to hold the seminar?Preferred Date*Secondary DateHow long would you like the seminar to last?*Ex: 1 day, 2-days, etc. Comments or questions?*
