Indiana University Purdue
University Fort Wayne

Physics-Based Calculus Workshop - Registration


1. Name _____________________________________________________________________

2. School/College______________________________________________________________

3. Mailing address _____________________________________________________________

4. Email address______________________________Phone____________________________

5. What courses do you normally teach? ______________________________________________

6. If you use computer software for instructional purposes, what do you use and in what courses?


7. How many years teaching experience do you have:__________in high school ___________in college?

8. Describe what you want to learn from this workshop. __________________________________ _____________________________________________________________________________ _____________________________________________________________________________

9. Are you interested in taking this course for continuing education credit? ___________
(Answering "yes" is not enough to register you with the University. We will forward your contact information to the Division of Continuing Studies, and if needed they will mail you forms for credit enrollment before the workshop begins.)

10. Assuming funds are available, are you interested in the participant reimbursement? ___________

11. Participants are encouraged to attend for the entire workshop schedule, but the organizers know that some schedule conflicts cannot be avoided. If you already know you can only attend part of the workshop, please indicate when you can be on campus to participate:


Please send this form to
Prof. Peter Hamburger, Department of Mathematical Sciences, IPFW, 2101 E. Coliseum Blvd., Fort Wayne, IN 46805-1499, to arrive by Friday, May 28, 2004.