Camp History Day

Registration Form

Please fill in the form below.
Contact Information
Full Name*

PrefixFirst NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number*

Area CodePhone Number
E-mail*

Confirmation Email
Gender*

FemaleMale
School Information
School/Agency Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School Email Address
example@example.com
How long have you been a teacher?*
Previous experience with NHD?*

YesNo
If so, how long?
Grades You Teach*
Subjects You Teach*
I am interested in receiving continuing education credit*

YesNo
Payment
Workshop Attendance*

Residential $650.00Commuter $325.00Out of State Coordinator $850.00
Payment Choice*

Credit CardCheckPurchase Order
Name on Check*
Check Number*
Please make checks out to Sacramento County Office of Education. Checks should be mailed to:

Sacramento County Office of Education (NHD-CA)

Attn: FS Accounts Receivable

P.O. Box 269003

Sacramento, CA 95826
To generate a purchase order, please print this registration form and the flyer to submit to your agency.
Name of Agency on Purchase Order*

My Products*

Residential Registration Fee$650.00

Commuter Registration Fee$325.00

Out of State Coordinator Registration Fee$850.00

Total $0.00

Please write a paragraph anwering the following: Why are you interested in participating in this workshop, and how will it assist you in your classroom or position?*

Registration Form