Class Registration Form

STEP 12: The 12^th Annual Conference on Science and Technology Education

SCHOOL/CLASS REGISTRATION OVERFLOW FORM
(Limited to 4^th thru 8^th grades)

*ALL FIELDS ARE REQUIRED*

School District:
School Name:

NOTE 1 : The session you want to attend is full. Please complete the form below to be placed on the overflow list and we will inform you of any cancelations. If you complete this form we will also notify you next year as soon as STEP 13 registration begins. To see if your area is covered for free transportation please click HERE. Our bus service will coordinate the bus pick-up schedules with the schools prior to the conference.

Select Session to attend:	Tuesday, October 25, 2011 - 9:00am to 12:00pm (4^th thru 8^th grades).
	Wednesday, October 26, 2011 - 9:00am to 12:00pm (4^th thru 8^th grades).

Principal Name

School Address:

Last:

City:

First:

Zip Code:

Teacher Name

School Phone:

Last:

Other Phone:

First:

School Fax:

Grade(s):

4 5 6

*School E-mail Address:

7 8

*Other E-mail Address:

Number of Students:

(See "Note 2" Below)

How did you hear about STEP?

Number of Required Adults:

**One adult required for every 10 students

Other:

*If no E-mail address is provided, your registration confirmation will be mailed or faxed to you. Please select a preferred confirmation method:

NOTE 2: STEP will provide up to two buses per school free of charge. Bus capacity is approximately 60 passengers per bus, including 1 adult chaperone for every 10 students. Please limit the number of students/adults to TWO bus loads per school (100 Students Maximum). If you would like to bring additional students on a first come, first served space-available basis, or provide your own transportation, please check below:

	I would like to bring additional students. Number of additional students:
	*You will be notified if additional space is available by September 15, 2010*
	I decline the STEP transportation and will provide my own.