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Hazen's Notch Association
Bringing People Together to Conserve Vermont's Natural
Resources
______ Education Program Registration Form
_____
To schedule an education program, complete this registration form and mail it to the HNA at P.O. Box 478, Montgomery Center VT 05471 or email the information to info@hazensnotch.org. We will confirm your program and the date(s) that you have chosen. Your confirmation package will include a summary of the program, a locator map and travel directions.
Please use a separate Registration Form for each program.
Program Title _______________ Date/Rain Date _______________________
Teacher's Name(s) ________________________________________________
Grade ______ Number of students ______ Number of Chaperones ______
Name of School _______________________ Principal __________________
Address _____________________________
Address _____________________________
Town ________________________________ State ____ Zip Code ______
School Phone _____________________ Email ________________________
School Fax _______________________
Teacher's Home Phone ___________________ Email ___________________
Time Plan to Arrive _______ Time Need to Depart _______
Travel by Bus / Cars ? (Circle)
Special Needs Students: ___________________________________________
________________________________________________________________
Comments _______________________________________________________
_________________________________________________________________
Program Fee: The program fee is based upon the number of students and the duration of your visit. Program fees range from $4 to $8 per student. We will quote the cost of the program when we reply to your fax or email.
Payment: You may pay with a school check, personal check or cash on the day of the program. If your school requires an invoice, please let us know in advance so that we may have it ready for you on the day of your program.
Rain Dates: Please call to confirm your program the day before you arrive. If there is any doubt about the weather for your group's scheduled day, we will - if needed - confer with you early in the morning of the day of your program.
Thank you !
Hazen’s Notch Association, Post Office Box 478, Montgomery Center VT 05471
T: (802) 326-4799 ~ F: (802) 326-4966
E: info@hazensnotch.org ~
W: www.hazensnotch.org
Copyright 2001-2010 Hazen's Notch Association for the Environment, Inc.
All Rights Reserved.
This page was last updated January 15, 2010.
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