Workshop Registration - Science

Please fill out the following information and press the SUBMIT button. For more information call the Golden Apple Foundation at 312/407-0006 x126. Fields marked by * are required.

*	First Name:
*	Last Name:
*	Address:
*	City:
*	State:
*	Zip Code:
*	Email Address
*	Phone Number:	- -
	School Information
*	School Name
*	Address
*	City
*	State
*	Zip Code
*	Principal:
*	Grades You Teach:	Check all that apply: Pre-K - 3 4 - 6 7 - 8 9 - 12
*	Subject Area(s):
*	How many years of experience do you have?:
	Yes, I plan to earn graduate credit from Benedictine University. I understand that payment for graduate credit is due on the first day of class. (note: please contact Golden Apple to find out the cost per credit hour)

Please check the following checkboxes to indicate you have read and understand the following policies
	1. Waitlist policy: Participants are taken on a first-come-first-served basis after the receipt of payment. Once the workshop has reached 40 participants, any additional registrants will be placed on a waiting list pending cancellations. Their payments will not be processed until confirmation of an opening.
	2. Cancellation policy: Any withdrawal from the workshop must be done by June 1st to receive full reimbursement of your fees. Cancellations after June 1st will be assessed a $30 cancellation fee.

	Registration fee: $300
*	I would like to pay by:	Credit Card Check



	Payments made by check should be sent to: Golden Apple Foundation, Summer Science Workshop, 8 S. Michigan Ave, Suite 700, Chicago, IL 60603