Educator Agventure Summer Agricultural Institute Registration

Educator Agventure Summer Agricultural Institute Registration

June 20-22 or 23, 2022 from 8:30 a.m. - 4:30 p.m. in Carlinville
Name *

First Name Last Name
School *
Grade/subjects taught *
School Email *
example@example.com
School Phone Number *
Please enter a valid phone number.
School Address *

Street Address

Street Address Line 2

City

Postal / Zip Code
Since this institute takes place during the summer, please share the following home information which will not be shared with anyone else.
Home Email *
example@example.com
Home/Cell Phone Number *
Please enter a valid phone number.
Home Address *

Street Address

Street Address Line 2

City

Postal / Zip Code
Please select one option. *

June 20-22 (earn 22.5 professional development hours) @ $25 (institute fee includes meals, hands-on activity supplies, & classroom resources) June 20-23 (earn 30 professional development hours) @ $30 (institute fee includes meals, hands-on activity supplies, & classroom resources) June 20-23 (earn 2 graduate credit hours from University of St. Francis) @ $30 (institute fee includes meals, hands-on activity supplies, & classroom resources). If this option is chosen, the participant will pay and additional $200 directly to USF when they register with them.
After submitting this form, please send your check for the institute fee to the Macoupin County Agricultural Education Foundation, P.O. Box 77; 220 N. Broad Street, Carlinville, IL 62626
Please describe what you hope to gain by attending the Summer Agricultural Institute. *
Lunch will be provided each day. If you have any food allergies we need to plan for, please list below.
Should be Empty: