Monarch Teacher Network Registration Form

Teaching and Learning with Monarch Butterflies

Name:____________________________________ Summer Email (Important!): _____________________

Home Address:_____________________________________________

City, State,______________________________ zip________________

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

School Name ______________________________________________________________

School Address_____________________________________________________________
 
No workshop space will be held until this completed registration form is received; if paying by PO, fax this form to us while your Business Office prepares a PO. Registration will be confirmed by e-mail.  Questions?? Call 856-582-7000.

Dates and Locations: Check preferred workshop and return form with $99 per person check or P.O. (payable to EIRC/Global Connections) to: Erik Mollenhauer, EIRC, 606 Delsea Drive, Sewell NJ 08080, or fax: 856-582-4206.

[  ] Aug. 6, 7, 8—Forest Park High School, Woodbridge, VA (Prince William County, Washington, DC area)
[  ] Aug. 11, 12, 13—Waples Mill School, Oakton, VA (Fairfax County, Washington, DC area)
[  ] Aug. 11, 12, 13—Knox Agri-Center, Galesburg, IL (Knox County, west of Peoria)
[  [ Aug. 18, 19, 20—Bergen Community College, Paramus, NJ (New York City area)
[  ] Aug. 19,  20, 21—Raritan Valley Community College, North Branch, NJ (Somerset County, central NJ)
[  ] Aug. 20, 21, 22—EIRC facility, Sewell, NJ (Gloucester County, Philadelphia  area)
 

Click here for a PDF version of the registration form.