Three Rivers Project Registration
Open to all teachers in Allegheny, Westmoreland, Butler Counties
Full Name
*
Prefix
First Name
Last Name
Title
*
School
*
Phone Number
*
-
Area Code
Phone Number
E-mail
*
What grades will participate?
*
Who will be installing the barrel at the conclusion of the program?
*
My School
Donating to another location in our community
Would you like to be added to a wait-list in the event we are able to provide you with more than one barrel?
*
No, only one!
Yes please!
How did you hear about us?
Please Select
Email
Flyer/Brochure
Another Teacher/Co-Worker/Friend
Social Media
Additional Comments/Questions
Submit
Should be Empty: