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APPLICATION

Fall 2002
Three-Day Workshops
(Print or Type)
Teacher Information

Name: _________________________________________________________

Address:________________________________________________________

              _______________________________________________________

Home Phone: _________________________

Email: ______________________________

 

School Information

Name: _________________________________________________________

Address: _______________________________________________________

              _______________________________________________________

County: ______________________________

Phone: _______________________________

Fax: _________________________________

 

Circle the workshop you wish to attend.

                      Module Title                                        Dates of Workshops             Fee
Watershed Watchdogs: Assessing Water Quality              October 23, 26, 30               $25.00
Talkin' Trash: Make a Litter Difference                            November 6, 9, 13               $25.00
Don't Get Sedimental: Runoff and Sediment in the River    December 4, 7, 11               $25.00

# of workshops: __________ x $25.00 = _______________ (please enclose this amount)

Mail application and a check (made out to Bridging the Watershed) to:

Bridging the Watershed
2001 Bryan Point Road
Accokeek, MD 20607

Confirmation of acceptance will be emailed to you.