CT GREEN PREP JANUARY-FEBRUARY 2009 REGISTRATION FORM
Print out this page and send to the address below with your payment.
Name____________________________________________________________________________
______
Company_________________________________________________________________________
______
Address_________________________________________________________________________
_______
Town___________________________________ State___________________
Zip_____________________
Phone____________________________________
Fax____________________________________________
E-mail__________________________________________________________________________
_________
Please Print Name(s) of Student(s):
1.______________________________________________________________________________
_________
2.______________________________________________________________________________
_________
3.______________________________________________________________________________
_________
____ Check or Money Order ____ Credit Card
Charge to Your Credit Card:
Card Number ___________________________________ Exp. Date________
Signature________________________________________________________
______ persons for the CT Green Prep Program
@ $100 per person = $ _______
______ UConn parking fee ($20 per car) $ _______
TOTAL CHECK/CREDIT CARD $ _______
Return this form along with the parking registration form and your payment to:
CT Green Prep Program
UConn Home & Garden Education Center
1380 Storrs Road, U-4115
Storrs, CT 06269
