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In order to register, you must print this form to mail or register by phone. It is NOT possible to register by computer at this time.

ESC Region VII Service Area Math-Science Coop Teachers should contact their representative to register.

REGISTRATION

Tuition/Fee:    $69.00

Course Title:   "Laboratory Safety and Hazardous Waste Recovery"  

August 4, 2006

Section No.:    SCIT2014  408054Q

SS# ___________________________

NAME __________________________________

Address ___________________________________

___________________________________

Home Phone______________________________

Business Phone __________________________

E-mail/FAX ____________________/__________________

If registering by phone:(903) 510-2900, VISA, MasterCard, or Discover required.  Please complete the form above and pay with check or money order if registering by mail. Send Form to:             

RTDC                         

1530 ssw Loop 323

Tyler, TX 75701