Educator Trek Registration Form

Registration for most Educator Treks is on a first-come, first-served basis. Treks fill quickly, so register early.

To register, print, complete and mail Educator Trek Registration Form and deposit check to:

      Mike Dunn, Coordinator of Teacher Education
      N.C. Museum of Natural Sciences
      11 West Jones Street
      Raleigh, NC 27601-1029

Participant Information

Name ______________________________________________________________________

Home Address _______________________________________________________________

City _____________________________________ State ________ Zip __________________

Phone H (_____)_______________________ W (_____)______________________________

E-mail H ________________________________ W __________________________________

Emergency Contact Name _______________________________________________________

Emergency Contact Phone Number ________________________________________________

School/Organization ___________________________________________________________

Grade/Age Taught ____________ School County ____________________________________

My reason(s) for wanting to participate in the Museum's Educator Trek(s):





Trek #
Trek Title
Trek Cost*
Deposit** ($25/Trek)
                       
 
  
   
 
  
   
 
  
   
 
  
   
 
 

 

Friends of the Museum teacher members receive a 15% discount

Make check payable to:
Museum Extension Fund
Deposit
Subtotal
 
MINUS Friends 15% Discount
 
DEPOSIT TOTAL
 
* Balance of Trek Cost is due upon acceptance.
** Deposit is non-refundable upon acceptance in program. Refunds on the balance of Trek Cost granted only when cancellation is received in writing at least two weeks before the program begins.


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