The EduCulture Project at

5th Annual Summer Institute on
Food, Farming, Culture & Education
August 1-5, 2011
Registration Form

Please PRINT, complete, and return this form with check or payment information to:
Global Source Education, PO Box 11316, Bainbridge Island, WA 98110

You can register by phone during office hours at 206-780-5797

Return to Global Source Home

Tuition Deposit $45	A deposit is required to reserve a place in this program. (applied towards tuition, refundable up to two weeks before start of the program). You will be billed for the balance of tuition after registration is received.
Full Tuition $295 for GSE members $315 for others $315 for GSE members $335 for others	FFCE Summer Institute Paid in Full Registered by June 15 Registered after June 15
$35 $_______	Global Source Membership/Contribution Other Tax Deductible Contribution to Support the EduCulture Project
$_______	Total Amount Due
Applicant's Name
Summer Mailing Address
Summertime Phone #
E-Mail
School/Organization/Farm

Grade Level, Position

Notes

Pay by check made to: Global Source Education
Pay by Credit Card (Visa or MasterCard accepted)
Credit Card Information    MasterCard     Visa    Exp Date ____/____
Credit Card Number    __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __

Date of Registration________________

Applicant Signature (required for registration) ________________________________