NSTA 2010 Order Form

SPECIAL INITIATIVE
* Please select your Special Initiative: NSTA 2010
SCHOOL/TEACHER INFORMATION
* School District * School Name NOTE: Please use the full school name (Example: Forest Wheeler Elementary School NOT Wheeler) School Address (Will NOT ship to P.O. Box) * Street * City * State * Zip * Teacher Name * Teacher Email Phone Number * Did you attend an AWIM workshop? No Yes Where: When: In which grades do you plan to use A World in Motion®? (select all that apply) 1 2 3 4 5 6 7 8 9 10 11 12
CLASSROOM MATERIALS
Materials Kit Price Quantity Elementary Activities Skimmer Materials Kit $65.00 Skimmer Materials Partial Kit $15.00 JetToy Materials Kit $55.00 JetToy Materials Partial $35.00 Electricity and Electronics Kit $225.00 Middle School Activities Motorized Toy Car Materials Kit $295.00 Glider Kit $120.00 Fuel Cell Materials Kit $380.00 Fuel Cell Student Kit $50.00 Fuel Cell Teacher Kit $50.00 Electricity and Electronics Kit Middle School $200.00 High School Activities Electricity and Electronics Kit High School $325.00 Total Quantity Total Cost
PAYMENT INFORMATION
Credit Card # Type of Card Name on Card PO # collection Specific Order Requests: If you prefer to call in your order, please call 1-800-457-2946.
PARTNER INFORMATION (Optional)
Note: A partner is a representative from your special initiative. The role of the partner is to contribute to the students' understanding of the engineering design, scientific, or technology experience. Partner Name: Partner Employer Name: Partner Occupation: Engineer Partner Employer Address Street: City: State: Zip:
* I agree to credit SAE International as the originator of the A World In Motion® curriculum in any publicity, interviews, or articles resulting in the use of the program.