Workshop Registration

Teaching and Learning with Monarch Butterflies

Print the attached form and send back to EIRC with your payment.  If for some reason you can’t print the PDF form you can cut and paste the wording on this page into a document and print it out

Name:____________________________________ Summer Email (Important!): _____________________

Home Address:_____________________________________________

City, State,______________________________ zip________________

Home phone: ____________________Grade:_______________ T-shirt size:_________

School Name ______________________________________________________________

School Address_____________________________________________________________
 

The fee for the Workshop is $99 per person. 

No workshop space will be held until this registration form is received; if paying by Purchase Order, please fax this form to us while it is being prepared.  Registration will be confirmed by e-mail.  If you have any questions call 856-582-7000 x110. 

Mail payment to:  Monarch Teacher Network™ at EIRC, South Jersey Technology Park, 107 Gilbreth Parkway, Suite 200, Mullica Hill, NJ 08062 

 Check (√) preferred workshop and return form with $99/person (payable to EIRC/Global Connections)