 Teachnology Gold Membership
Offline Site License Mail Sign-up Form |
Note: All information provided on this form is kept in strict confidence.
1. Contact Information
Name _________________________ School or
Organization Name: ______________________
Street Address: ______________________________________________________________________
City:____________________________________ State: _____________ ZIP Code:
___________
Country: ________________________ E-mail Address: __________________________________
Daytime Phone: __________________________________ Fax: ___________________________
2. Billing Information
Purchase Order / Check #:__________________________________________________________
Date Authorization Issued: __________________________________________________________
Authorized Name: ________________________________ Title: ____________________________
3. Choose # of Staff Members Included
With License ( Prices are in U.S. Dollars)
______ 13 - 25 Teachers: Grants one year of access to 13 - 25 Teachers.
$350.
______ 26 - 50 Teachers: Grants one year of access to 26 - 50 Teachers.
$500.
______ 51 - 75 Teachers: Grants one year of access to 51-75 Teachers.
$650.
______ 76 - 100 Teachers: Grants one year of access to 76-100 Teachers.
$750.
4. Licensing Agreement
All materials can be used and photocopied for classroom
use only. Our products cannot be used for commerical means.
Signature: X_______________________________________________
5. Submitting Order
In order to finalize the order:
- Choose an email address that will serve
as the Username for this account: _______________
- Choose a password for this account: _________________
- Mail purchase order, check, money order, or credit card information to:
Teachnology, Inc.
Attention: Getworksheet.com
PO Box 1107
Truro, MA 02666
USA