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Region
3 Marketplace for Kids Education Day
Tuesday, March 13, 2012
Lake Region State College - Devils Lake, ND
PART 1: CLASS/GROUP REGISTRATION FORM
(Please complete all information!)
Do not use the back button on your browser! Doing so could cause your registration to be lost!
* Denotes a required field!
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| Name of Regional Education Association:* |
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Name
of School/Organization:*
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Grade:* |
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Complete
Mailing Address of School/Organization:*
(your Education Day
Materials
will be mailed to this address)
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City/State/Zip
Code:*
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Title:*
(Miss, Mrs., Ms., Mr.) |
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| Classroom Teacher/Advisor:* |
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More than one teacher registering? |
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| If more than one teacher is registering, please list: |
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Teacher Telephone (Daytime):*
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Teacher
Telephone (Evening):*
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| Teacher Email Address:*
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| Name of Person Completing Form:* |
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Relationship to Classroom (i.e.,
parent, student teacher, etc.)* |
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Person to Call to Verify Information on
Registration Forms:*
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Telephone Number and Best Time to Call:*
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PLEASE
ANSWER THE FOLLOWING QUESTIONS:
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Total Number of Registrants:*
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Do you have any special needs/ADA requirements? |
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Total Number of Students:*
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If yes, please explain: |
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Number of Students Exhibiting a Project:*
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Number of Chaperones:*
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Lunch: Students may bring a sack lunch, or purchase lunch from Lake Region State College for $5.00. Lunch from Lake Region State College will include a choice of chicken burger or sloppy joe, assorted chips, tossed salad with dressing, pickle spear, cookie, and choice of soda or milk. Pre-registration for lunch is required! Sack lunches can be stored in the Dining Room.
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We will bring our
own sack lunch(es). |
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We will purchase lunches from Lake Region State College. |
Questions?
We want your registration to run smoothly, and we are here to help you!
If you need assistance, or have any questions, please do not hesitate
to contact Marilyn or Stacey at 1-888-384-8410 or 701-663-0150 or email renee.kipp@marketplacend.org
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