* 1. First Name:

* 2. Last Name:

* 3. Organization/School Name:

* 4. Street Address:

* 5. City:

* 7. Zip Code:

* 8. Country:

* 9. Email:

* 11. What grade(s) do you teach?

* 12. What time of the year do you feel teacher attendance would be highest at a local, off-site professional development event?

* 13. What day of the week do you feel teacher attendance would be highest at a local, off-site professional development event that is not sponsored by your school/district?

* 14. Which of these days/times do you feel would be best for a local, off-site professional development event that is not sponsored by your school/district? Please rank the days/times from 1 to 4 with 1 being the most preferred, and 4 being the least preferred. (If you are not a teacher, enter "not a teacher" in the Comments field.)

  1 2 3 4
Thursday, 5-8pm
Friday, 5-8pm
Saturday, 8am-noon
Saturday, 1-5pm

* 15. Please rank the following professional development events according to how interested you would be in attending the event. 1 = most interested, and 4 = least interested. (If you are not a teacher, enter "not a teacher" in the Comments field.)

  1 2 3 4
Get Your Hands On Manipulatives (grades preK-5, all subjects)
Literacy & Math Intervention with Manipulatives (grades K-5)
Manipulative-based Instruction Just for Early Learners (grades preK-2, all subjects)
Manipulative-based Methods for Special Needs (grades preK-5, all subjects)

* 16. If you were to attend a professional development event, which of the following would you prefer to walk away with as part of the registration fee:

* 17. How much would you expect the registration fee to be for an off-site, HALF-DAY professional development event in your local area? Keep in mind that you may receive products/gift card with a value equal to the registration fee at the event.

* 18. If you were to attend an off-site professional development event in your local area, who would most likely pay your registration? Keep in mind that you may receive products/gift card with a value equal to the event's registration fee.

* 19. If you win the "Hot Picks" contest, which of the following products would you like as your prize?

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