Summer Seminar 2004
Dear Teacher,
Summer Seminar Fourth and Fifth Grade History Teachers & Secondary English and American History Teachers
Please print this form, fill it out and return to Old Alabama Town
 Your Information
_____ June 7th -11th, 2004   (please chose one or both events)
E-mail Address: _______________________________
First Name: _______________________________
Last Name: _______________________________
Address: _______________________________
City:
 _______________________________
State:
 _______________________________
Zip:
 _______________________________
Phone: _______________________________
 School Information
Name of School:
 ______________________________________
Address of School: ______________________________________
City:
 ______________________________________
State:
 ______________________________________
Zip:
 ______________________________________
Phone: ______________________________________
 Additional Information
I have been teaching for __________ years.
I have been teaching Alabama History for __________ years.
Please tell us about the other subjects and grade levels you teach:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Will you (or this teacher) be assigned to teach Alabama History for the 2004 - 2005 school year?         YES          NO
What opportunities will you (or this teacher) have to share this Summer Seminar training with other teachers?
__________________________________________________________________
__________________________________________________________________
 Future Contact
In the future contact me via: E-mail      Phone      Snail-Mail      Don't Contact Me
Join our mailing list for special events seminars, etc (about 4 a year):
Yes, e-mail it to me      Yes, mail it to me      No, not at this time
Once you have completed this form please fax it to our offices at 334-240-1850 Attention Florence Giles
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