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.)

  • Phone

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?*