E-Learning for Educators

E-Learning for Educators
http://www.elearningmo.org
e-mail: elearning@missouri.edu
Phone: (573) 884-4233

Learning and Teaching with Web 2.0 Tools – Fall 08

Personal Contact Information:
First Name:*
Last Name:*
E-Mail Address:*
Alternative E-Mail Address:
Street Address:*
City:*
State:*
Zipcode:*
Phone Number:* (Please include area code - example: 111-222-3333 )
Alternative Phone Number: (Please include area code - example: 111-222-3333 )

Professional Affiliation:
School District/Organization:
Building Name:
State:

Billing Information:

Please select your payment method and billing information. If your billing address is different than your personal address then please enter that information in the appropriate fields. (Courses are $125.00 per course, if you have a valid scholarship code your final bill will be discounted accordingly.)
Payment Method:

  -  Check #
 - Purchase Order #
(If paying by credit card please call (573) 884-4233 to provide your credit card info)

Do you have a scholarship? Yes, I have a scholarship - Scholarship Code
  Scholarship recipients who choose to take the course for graduate credit are responsible for the $100.00 per credit hour fee.
District Name:
District Contact First Name:
District Contact Last Name:
District Contact Phone Number:  (Please include area code - example: 111-222-3333 )
District Contact E-Mail:
Billing Address:
City:
State:
Zipcocde:

Graduate Credit Options:
Are you interested in seeking graduate credit for this course?
if you selected "YES", from which institution will you seek graduate credit?