Partnership Registration Form

Partnership desired*:

Network (FREE)

*For a description of the FREE NETWORK partnership, CLICK HERE.

Please provide the following contact information:

Name:

Grade(s) Taught:

School:

Position:

Principal:

School Address (P.O. Box or street):

City:

State:

Zip/Postal Code:

School District:

County:

School's Electric Provider:

Work Phone:

Best time to reach:

Work FAX:

Home Phone:

Home Address (include city, state and zip)

E-Mail Address:

Select a Workshop:
None Nov. 30 Shawnee State University Fair - CLOSED/FULL Dec. 05 Cincinnati Fair Dec. 14 Otterbein College Fair - CLOSED/FULL Jan. 11 University of Akron Workshop - CLOSED/FULL Jan. 12 Great Lakes Science Center Workshop - CLOSED/FULL Jan. 22 Zanesville Workshop Jan. 23 OU Athens Workshop Jan. 26 Bowling Green State University Workshop - CLOSED/FULL Jan. 30 Tipp City Fair

Energy Workshops and Fairs: maximum 6 students (workshops) and maximum of 30 students (fairs). Bringing Maximum Number of Students?
Yes No
If "No" please indicate the number of students in the comments section below!

I would like to bring additional students (Contingent upon available space):
Yes No
Please indicate number of additional students you would like to bring in the comments section below!

Additional Comments: