Registration Form

2004 Big Island Education Days
143 West Clark Street, Albert Lea, MN 56007
507-373-3938

Name of School_____________________________________________________________________

Name of Contact Person _______________________________________________________________

E-Mail Address _____________________________________________________________________

Day Phone ( )______________ Evening Phone ( )_____________ Fax ( )________________

Mailing Address _____________________________________________________________________

City/State/Zip _____________________________________________________________________

NEW SCHOOLS ONLY:

Number of Students and chaperones @ $5 each ____ Grade(s) of students _____

Number of Teachers (no charge) ____

RETURNING SCHOOLS:

Number of Students and chaperones @ $6 each ____ Grade(s) of students _____

Number of Teachers (no charge) ____

REGISTERING AFTER SEPTEMBER 12, 2004

Number of Students and chaperones @ $7 each ____ Grade(s) of students _____

Number of Teachers (no charge) ____

Number of _______ Buses _______ Vans _______ Private Cars

Arrival Time _______________ Departure Time _______________

(This will be confirmed in September)

Because all classes are scheduled on the 1/2-hour, please schedule classes as follows:

First class to begin at _______________ Last class over at _______________

(Please remember, you will need time to get your lunches and look over your schedule once you arrive on site, and time to organize your students before your bus is scheduled to depart)

We would like to attend Big Island’s Education Day on:

______ Thursday, September 30, 2004 ______ Friday, October 1, 2004

Signature ___________________________________ Title _________________________________

Please return this form ASAP.

Mail to: Big Island Education Days
143 West Clark Street
Albert Lea, MN 56007
Fax to: 1-507-373-0344