Teacher's PREP Registration

REGISTRATION FORM

Subject:

Your Email Address: **Must Include

Name:

Preferred Title: Dr. Mr. Mrs. Ms. Miss None

First Name:

Last Name:

Home Address:

Street:

City:

Province:

Postal Code:

Country:

Home Telephone:

Home Fax:

School Information:

School You Teach At:

Grade or Subjects Taught:

Get Involved (Answer Yes or No):

Contact Me About Being On P.R.E.P. Committee Yes No

Place Me On The P.R.E.P. Snail Mail List Yes No

Place Me On The Teacher's P.R.E.P. Listserve Yes No

Registration Fee:
We ask a registration fee of $10.00 per year to help offset the costs of mailing and printing. We however do not believe that money should stop someone from joining us, therefore if you can not afford the $10.00 per year, join anyway and enjoy!!

I will mail the $10.00 to the address below immediately:

I would like to join and will forward the $10.00 when I can:

Street:
City:
Province:
Postal Code:
Country:
Home Telephone:
Home Fax:

Contact Me About Being On P.R.E.P. Committee	Yes	No
Place Me On The P.R.E.P. Snail Mail List	Yes	No
Place Me On The Teacher's P.R.E.P. Listserve	Yes	No

I will mail the $10.00 to the address below immediately:
I would like to join and will forward the $10.00 when I can: