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PA Ag in the Classroom

 

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Especially for Kids

Next Workshops:

Level I will be July 12-17, 2009
Level II will be April 24-26, 2009




 
 

Participant (Teacher) Registration Form

Sponsor Form         Nominate a Participant

Participant Information

Participants are accepted on a first-come, first-served basis. No final papers from teachers will be accepted after June 13, 2008 . Participants are responsible for a $100 non-refundable registration fee.

Two Ways to Register


1. Register electronically. Currently you must send in a check to complete registration. Check must be received with 7 business days to keep your spot for the classroom.

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

Participants should submit this form with a $100 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
Name
Gender   
Grade(s) and Subject(s)
Name as you would like it to appear on your NAME TAG:
Home Address
Home Phone:
County:
School District:
School Address:
Email:


Teachers are personally responsible for a $100 fee with their FINAL information form.

Sponsorship:

I have a sponsor:      

If yes, who?

If no, would you like assistance in securing sponsorship?   

Credits:

I plan to take this course for credit:

    

If Yes, please print out this form as your social security number will be required and this is not a secure webpage. Write your number in the space below on your printed form.

If Yes, please indicate credits you wish to apply for:

60 Act 48 hours

IU Professional Education Graduate Credits. IU fees for credits are the responsibility of the participant.

2-3 Penn State Graduate Credits (PSU will send information only to those wanting graduate credits). PSU fees for credits are the responsibility of the participant.

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 the room charge)
I live close enough to commute. (Classes begin at 8 a.m. and end each day about 8 p.m.)

Administrative:

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:
All registration forms and payments must be received before June 13, 2008 . Registration fee must be paid prior to receiving sponsorship assistance. Sponsorships are awarded in accordance to the sponsoring organizations instructions and 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