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Next Workshop:
July 13-18, 2008

 
 

Ag in the Classroom Level II
Alumni Workshop Participant Registration Form

 

2008 Agriculture in the Classroom II Workshop
Delaware Valley College, Doylestown, April 25-27, 2008

Participant Information

Participants are accepted on a first-come, first-served basis. Ag in the Classroom II is open to all Ag in the Classroom alumni, but is limited to 40 participants. Participants are responsible for a $50, non-refundable registration fee.

Two Ways to Register


1. Register electronically. After you fill out the application below and submit it, you will be automatically taken to the Paypal website. You will be able to securely use a credit card (VISA, MasterCard, American Express or Discover) to pay the registration fee whether or not you have an account with Paypal. If you have a Paypal account, you may use your Paypal account to pay for the registration.

2. Print out an application and return it via US mail with your check.

Participants should submit this form with a $50 non-refundable registration fee the address below. Application will not be complete until payment is received at Pennsylvania Farm Bureau.

Please make checks payable to:
Pennsylvania Friends of Agriculture Foundation
c/o Ag in the Classroom
PO Box 8736 · Camp Hill, PA 17001-8736

  Electronic Application

After you fill in the form below and submit the information, you will be taken to Paypal's secure payment page. You may choose to use VISA, MasterCard, American Express, or Discover through Paypal. It is not necessary to have a Paypal account to do so. If you do have one, you may also log in and use your own Paypal account.

*Must be filled in.

Date Submitted
First Name*
Middle Name
Last Name*
Gender   
Grade(s) and Subject(s)
Name as you would like it to appear on your NAME TAG:
Home Address
City*  
State*
Zip*
Home Phone:
County:
School District:
School Address:
Email:

FEES: $50 registration fee required with this registration (This is the responsibility of the participant and is nonrefundable after February 25, 2008)

Sponsorship:

I have a sponsor:      

If yes, who?

If no, would you like assistance in securing sponsorship?   

Credits:

15 Act 48 hours

Please provide your PPID1 here:

Housing:
Reservations and roommate assignments at the State College Super 8 will be made for participants. Rooms will be on a master bill.  Participants are responsible for incidentals.

has agreed to be my roommate.


Assign a roommate to me. (Take this opportunity to get to know another teacher.)
I require my own room. (You will be responsible for 1/2 the room charge)
I live close enough to commute.

Administrative:
Year you attended Ag in the Classrom
summer workshop
Who recommended this course to you?
Please include me (work contact information only) in the AITC Educators Directory.  
Indicate any special medical, physical or dietary requirements:

Registrations are limited to 40 applicants and are accepted on a first-come-first-serve basis.


 






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© 2008 Pennsylvania Farm Bureau · General Office: 510 South 31st Street, P.O. Box 8736 Camp Hill, PA 17001-8736 · 717.761.2740