The EduCulture Project at

Summer Institute on
Food, Farming, Culture & Education
2010 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	Deposit (towards full tuition) Required to to reserve a place in this program. You will be billed for the balance of tuition. (Refundable up to two weeks before start of the program.)
Full Tuition $275 for GSE members $295 for others $295 for GSE members $315 for others	FFCE Summer Institute Paid before June 15 Paid after June 15
$35 $_______	Global Source Membership/Contribution Other Tax Deductible Contribution to Support the EduCulture Project
$_______	Total Amount Due
Name
Mailing Address
Summertime Phone #
E-Mail
School

Grade Level, Position

Notes

Please make checks payable to: Global Source Education
Credit Cards (Visa or MasterCard) accepted
Credit Card Information    MasterCard     Visa    Exp Date ____/____
Credit Card Number    __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __
Date ________________
Applicant Signature (required) ________________________________