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.)

• Email

This field is for validation purposes and should be left unchanged.

1. Professional Development Interests

• Which 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 select
  In a mailing
  On the web
  In an ad in a book
  In materials included in my last package from Brookes
  At a conference
  It was recommended by a friend/colleague
  From a customer service representative at Brookes

2. Contact Information

• First name*

• Last name*

• Title*

• School/Organization*

• Address*

• Country*

  • United States
  • Canada

• City*

• State*

  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
  • Armed Forces Americas
  • Armed Forces Europe
  • Armed Forces Pacific

• Province*

  • Alberta
  • British Columbia
  • Manitoba
  • New Brunswick
  • Newfoundland & Labrador
  • Northwest Territories
  • Nova Scotia
  • Nunavut
  • Ontario
  • Prince Edward Island
  • Quebec
  • Saskatchewan
  • Yukon

• Zip/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 Information

Telling 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 Date

• How long would you like the seminar to last?*

Ex: 1 day, 2-days, etc.

• Comments or questions?*