College of Agriculture, Human and Natural Sciences
Cooperative Extension Program
2016 Third Tuesday Field Days & Educational Workshops
Registration Form
Workshop name: ______________________________________
Workshop date: _______________________________________
Participant Contact Information:
Name: __________________________________________
Address: ________________________________________
________________________________________
Phone: _____________Email: ________________________________
Payment Information:
Payment ($15.00) may be made by cash or check onsite prior to the workshop (a table will be set up near
the workshop area to facilitate this). Lunch is included. Please pre-register with this form as seats are
limited. Please arrive early to complete registration (9:30 am). Workshops begin at 10:00 am.
Please check one of the following:
Payment: ____Cash (onsite) _____ Check (onsite)
Please email completed form to [email protected] Thank you for your participation!