Participant Information

 

Curriculum Leader____________________________________ E-Mail Address__________________

Mailing Address_____________________________________________________________________

Do you have special dietary needs? ____________________________________________________

Gender__________________ Other special needs?________________________________________

Will you share a room with someone on your team?__________ Who_________________________

 

Technology Leader____________________________________ E-Mail Address__________________

Mailing Address_____________________________________________________________________

Do you have special dietary needs? ____________________________________________________

Gender__________________ Other special needs?________________________________________

Will you share a room with someone on your team?__________ Who_________________________

 

Principal Leader #1_________________________________ E-Mail Address__________________

Mailing Address_____________________________________________________________________

Do you have special dietary needs? ____________________________________________________

Gender__________________ Other special needs?________________________________________

Will you share a room with someone on your team?__________ Who_________________________

 

Principal Leader #1_________________________________ E-Mail Address__________________

Mailing Address_____________________________________________________________________

Do you have special dietary needs? ____________________________________________________

Gender__________________ Other special needs?________________________________________

Will you share a room with someone on your team?__________ Who_________________________

Return completed form no later than January 14, 1999 to:

Robin Brower, MSU College of Education
514C Erickson Hall, East Lansing, MI  48824
Email:  browerr@pilot.msu.edu
Phone: (517) 353-8950
Fax:     (517) 353-6393

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