LLSP Event Registration

Life Lab Events - Secure Registration Form

Workshops & Events

please check
only ONE
event or
workshop.


	August 24 Discovering the Garden in Early Childhood Education Registration Deadline: Friday 8/10 - $150 per person (link to anchor on workshops.html - make popup links use style sheets to spiff up some more.
	September 15 A Taste of the Harvest: Life Lab's Annual Benefit Registration by: Saturday 9/1 - $35 per person
	September 27-28 The Growing Classroom Registration Deadline: Friday 9/14 - $300 per person

Contact Info / Address

*Star fields are required.

Name:

* (change to first/last)

Child’s Name:

ONLY if registering a child

Mailing Address:

City:

* State:* Zip:*

Phone:

Email:

Additional
Attendees

  Names:
  Total number of people attending:  *

Title/Grade Level Teaching

ONLY if attending workshop/conference

Payment Options

I will be paying by:

	Credit Card submission. Card No: Expiration Date: Billing Zip: Print a copy for your records!
	Credit Card by Phone Call 831-459-2001 with card information.
	Check		Purchase Order
	To pay by check or purchase order, print this form and send it with your payment to: Life Lab Science Program - Event Registration 1156 High Street, Santa Cruz, CA 95064
	This secure form will be proccessed in our office and a confirmation & receipt will be sent to your address listed above. Confirmation and receipt will be sent by mail unless you specify otherwise in comment field below:

Questions ? Please call us at 831-459-2001 or send email to Questions.

*** Please print a copy for your records. *** (1841)