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2022 Community Science Teacher Workshop
Contact Information
Name
*
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First Name
Last Name
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Email
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Address
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City
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Country
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Teacher Information
Where do you teach?
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Please include the school name and county.
What subject(s) and grade(s) do you teach?
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Emergency Contact Information
Emergency Contact Name
*
Prefix
First Name
Last Name
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Emergency Contact Phone
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Physician Office Name
Physician Phone
Medical Conditions
*
N/A if none
Allergies
*
N/A if none
Questions?
Please contact Ryan Rebozo at
rrebozo@vtecostudies.org
for more information or with any questions.
I certify that I am fully vaccinated and boosted against COVID-19 according to current CDC recommendations.
*
Yes