2019 Summer Ag Institute Registration
Event Timing: June 18th-20th, 2019
Name *
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Email *
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Home Address
Address
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City
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State
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Zip
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Contact Information
Phone Number *
Please list Home phone or Cell Phone
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What is the best way to contact you? *
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Emergency Contact Name *
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Emergency Contact Phone Number *
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Allergies, Dietary or Medical Needs? *
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Shirt Size *
Please select the county that you teach in *
School *
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Grade/Subject that you teach *
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School Address *
Street, City, State, and Zip
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Would you like to attend a Cardinals Baseball game on Tuesday evening? It will be an all inclusive event (food, alcohol, fountain drinks and air conditioning!), costing an additional $50 dollars due at time of registration. *
Hotel Information: we will cover the cost of a room for you to share with one other occupant. Please comment under "other" if you have a preference on a roommate. If you would like your own room, it will be an additional cost of $175, in addition to the registration fees. *
Payment
Please mail your check to the address in your confirmation email.
I understand that I must pay $250 registration fee by Monday, May 20th *
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Please select your form of payment *
Ball Game *
Hotel Room *
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