Please PRINT, complete, and return this form with check or payment information to:
Global Source Education: PO Box 11316, Bainbridge Island, WA 98110
or FAX to 206-780-5797
Food, Farming, Culture & Education Institute, July 28-31
$35
Global Source Membership
Date of Registration
Name (First – Last]
Mailing Address
Day Phone
E-Mail
School/Organization
Grade/Subject Area
Notes
Clock Hours are available at additional cost
You can register by phone during office hours at 206-780-5797
Please make checks payable to: Global Source Education
Credit Cards (Visa or MasterCard) accepted
Credit Card Information MasterCard
Visa Exp Date ____/____
Credit Card Number __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __
Signature (required to register) ____________________________________