Registration Form

EDUC 590: Physical Science for Elementary Teachers:  Focus on Chemistry

June 9-20, 2008, 8:30 - 3:30 daily,  Lewis Hall, 212

Tuition: $225 for the course     Contact: Dr. Marge Legg 333-6370

NOTE: You must reserve your seat in the class by ALSO registering for AUDIT status at the Mississippi Bend AEA site.
After filling in this form, you will be directed to the AEA9 site.

Please provide the following contact information:

First Name
Last Name
Middle Initial
Home Address
City
State
Zip
Home Phone
E-mail

Please provide your current teaching position:

School
Grade
Street Address
City
State
Zip
Work Phone

I want to enroll in

Have you ever previously enrolled at St. Ambrose?:

Yes for Kids & Chemistry
Yes for Other Courses
No

Dr. Marge Legg.
Revised: 02/01/08