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Summit Registration

Please complete all information below. (*) denotes a required field.

To register for more than one Summit, you must fill out a new copy of this form for each course.

(*) First Name:

(*) Last Name:

(*) Sex: M F

Home Mailing Address:
(*) Street Address:
(*) City:
(*) State: (*) Zip:

(*) Home Phone: (your home phone is required for registration)

(*) Personal, Year-Round E-mail Address: (Important: we will send all correspondence to this address. Please double-check spelling and enter ONE address only!)

(*) School Name (if not listed, select *** NOT ON LIST ***):

    NEW SCHOOL INFORMATION:
    (only needed if your school is NOT on the above list)

    New School Name:

    School Mailing Address:

    School City, State, Zip:

    School Phone:

(*) Your Position/Title:

(*) Grade Level(s):

(*) Content Area(s):

(*) Summits (choose ONE)

Physiology & Fitness Estes Park, CO July 6-12, 2007 3 Credits
Endangered Species Portland, ME July 8-14, 2007 3 Credits
Writing & Illustrating History Boston, MA August 1-7, 2007 3 Credits

Check here if you will be taking the summit for college credit.

Housing

Please indicate any food allergies:

Please note any special needs we should be aware of:

Roommate Request:

(Note: For most courses, single rooms are not available. When single rooms are available we provide them for everyone on the course. We arrange double occupancy rooms for all other events.)

Fees / MOU Slots

(*) Select one:
My registration is covered by ELS contract (regular MOU slot).
I am a school principal, registering for one of our Principal Slots.
My registration is not covered by ELS contract: I will send the full payment upon acceptance of my application.

(*) Yes, I understand that in the event I need to cancel, I must fax or e-mail my cancellation at least three weeks prior to the start of the course. (FAX to 845-424-4280, e-mail to [email protected]). The school will be billed for $250 for any no-shows or cancellations within 3 weeks of the start of the institute unless ELS can fill the slot..