The Nature Institute 20 May Hill Road Ghent, NY 12075 tel (518) 672-0116, fax (518) 672-4270 info@natureinstitute.org, www.natureinstitute.org

2008 Registration Bringing Science to Life
July 6-12

Please mail or fax this registration form by June 1

Name _________________________________________________________

Address _______________________________________________________

City ______________________ State _________________ Zip __________

Home phone ______________________ Work phone ___________________

Fax ________________________ E-mail _____________________________

I teach at _______________________________________________________

My subjects are: __________________________________________________

Course Fee:  $520 (less $30 if paid by May 1).

Please pay in full by check (payable to The Nature Institute) or by credit
card with your registration.

I hereby authorize The Nature Institute to charge my credit card for the
course fee in the amount of ____________.

Name on Credit Card ______________________________________________

Type of Credit Card (circle one): Master Card / Visa

Card Number ____________________________ Expiration Date ___________

Signature of Card Holder ___________________________________________

____ I wish to stay in private home and need housing for ______ nights.
____ I would like more information about housing options.
____ I will arrange my own lodging.
____ I expect to have my own transportation.
____ I expect to need transportation.

Please let us know if you have any special needs.

If you cancel your registration more than two weeks prior to the beginning of the
course, you will be refunded the course fee minus $50.  If you cancel less than two
weeks before the course begins, you will receive a refund of the course fee minus $100.