Bug's World Registration

Registration deadline: 4/1/10

School:
Grade:
Teacher First Name:
Teacher Middle Initial:
Teacher Last Name:
Address:
City:
State:
Zip:
Email:
Phone:
Fax:
Total # of Students Attending:
Special materials or services you require for a disability:
Number of Adults:
If your group is more then 30, how do you want the group divided? Example: 1. Mrs. Houin: 21 students, 3 adults:
Preferred date: April 13    April 14   
either date   
Earliest Session you could arrive for:
Lastest session you could stay for (each session will last 30 minutes from its start time):
Maximum number of sessions to attend:
Minimum number of sessions to attened:
Please rank your top 10 choices for sessions you would like to attend:
Bug Zoo:
Busy, Busy Bees:
Cafe Insecta:
Can Insects Make You Sick?:
Collecting & Preserving Insects:
Critters Up Close:
Fly Fishing & Fly Tying:
Insect Olympics:
Insects & Plants: Combat:
Insects in Ag & Ecology:
Pollination Jubilation:
Whiz Bang Science Show:
Who's Eating My Lunch?:
Your Insect Friends:
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