Registration Application (Please print)

I and my child wish to register for the Bottle Biology series of Science Saturdays to be held on the mornings of February 28, March 27, and April 24. I have completed the application below and included my letter describing what I and my child hope to gain from participating. I am also enclosing a check for $30 payable to the Wisconsin Initiative for Science Literacy.

Child's name: ______________________________________________________________________
                               (first)                                                          (last)

Child's age: _____ years             Child's grade: ______

Name of child's school: _______________________________________________________

Name of child's teacher: _______________________________________________________

Name of participating
parent or guardian: ___________________________________________________________________
                                           (first)                                                          (last)

Address: __________________________________________________________________________

                               (city)                                                          (zip code)

Parent's home phone number: ____________________________

Parent's Email: _______________________________________________________________

Parent's signature: ________________________________________________________________

Print, complete, and mail with your letter and check by February 6th, 2004 to:

          Wisconsin Initiative for Science Literacy
          Department of Chemistry
          1101 University Ave.
          Madison, WI 53706-1396