Teacher Information Form

Teachers are the glue that makes this program stick together!   We want to know that we have your correct contact information to receive communications from us the way you want to see them! Take a minute to complete this form and you will be entered to win prizes in our monthly prize drawings!

2011-2012 School Year Information
(NOTE: you must be 18 years of age or older to fill out this form)
Teacher Name (required):
Email Address (required):
School:
Grade:
# of Students:
Are you familiar with our programs?
Yes         No
Would you like to receive a monthly update newsletter?
Yes        No
Mailing Address if you would prefer a hard copy newsletter:
Are you willing to organize a day of presentations at your school?
Yes      No      Maybe
Would you like a presentation in your classroom?
Yes      No      Maybe
Additional Comments: