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EstuaryLive 2009 Registration Form
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Contact Information (* ) fields are
required.
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First Name*
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Last Name*
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School/Organization/Institution*
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School Address
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City
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State
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Zip Code
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Country (If US, please leave it blank)
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Email*
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Phone
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Grade level(s) you teach:*
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Title:
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Primary subject taught: (Choose all that apply) |
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Which fieldtrips will you and your classroom participate in? please note, all times are listed as Eastern Daylight Time (EDT)*
(Choose all that apply) |
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What is the total number of students that will participate in the fieldtrip(s) checked above? |
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How many classes will participate in the fieldtrip(s)? |
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How did you hear about EstuaryLive?*
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Would you like to participate in our EstuaryLive program evaluation? (An independent program evaluator will follow-up with those teachers interested in participating in the evaluation) |
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Comments/Questions |
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