University of Colordado Denver STEMapalooza
October 8
th
-9
th
, 2010
Colorado Convention Center, Exhibit Hall B
K-12 Field Trip Registration Form
Contact Information
Teacher First Name
*
Teacher Last Name
*
School Name
*
District Name
*
Grade(s)
*
Number of Students
*
Number of Teachers
*
Number of Chaperones (1:7 Ratio REQUIRED)
*
1st Choice Selection for Session:
Date
*
Friday, October 8th, 2010
Saturday, October 9th, 2010
Session
*
Session 1 (9:00am-12:00pm)
Session 2 (10:00am-1:00pm)
Session 3 (11:00am-2:00pm)
Session 4 (1:00pm-4:00pm)
2nd Choice Selection for Session:
Date
*
Friday, October 8th, 2010
Saturday, October 9th, 2010
Session
*
Session 1 (9:00am-12:00pm)
Session 2 (10:00am-1:00pm)
Session 3 (11:00am-2:00pm)
Session 4 (1:00pm-4:00pm)
Mailing Address
*
City
*
State
*
Zip/Postal code
*
Phone (with area code)
*
E-mail Address
*
Confirm E-mail Address
*
Additional Accommodations
Please note
: You are NOT officially registered for the field trip days/times you requested above. There is a chance you may still be wait listed for the trips you requested. You will receive confirmation of your trips via e-mail in about a week.