Environmental Issues Instruction (eii) Workshop Registration

Workshop Location

First Name (required)

Last Name (required)

Preferred E-mail address (required)

Home Address

City

State

ZIP

Phone Number

Courses/Grade Taught

School

School Address

City

State

ZIP

Vegetarian Meals?

YesNo

Other Dietary Needs

Do you need lodging?

YesNo

Gender

Single Room Preferred? (Pay 1/2 cost)

YesNo

Payment Options

Full Payment ($275)Partial Payment ($150), Remainder at Workshop ($125)

Click here for online payment
or send check made out to Upper Iowa University to:
Dr. Barbara Ehlers
Eii
605 Washington St.
Fayette, Iowa 52142

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