Atech > TEC > Workshop Registration Form

Required Fields (*)

First Name: *

Last Name: *

Address: *

School/Group Affiliation:

City: *

State: *

Zip: *

Work Phone:

Home Phone: *

Email Address:

Workshop Title: *

Training Date: *

Fee:

Location:

Payment Method

Will Mail Check Enclosed

Purchase Order #

Will Pay day of workshop

To request additional information or accommodations please use the box below:

If you have any questions call (603) 226-2900 or email LeoB@atechservices.org

Make checks payable to: ATECH Services

Technology Exploration Center
117 Pleasant St. 2nd Fl. Dolloff Bldg.
Concord, NH 03301
(603) 226-2900

Our Workshops are sponsored in part by
Assistive Technology in New Hampshire (ATinNH),
the New Hampshire State Program on Assistive Technology!