First Middle Last

Home Address

City Postal Code Phone

School Name

Address

City Postal Code Phone

Email Social Security Number

Male Female Birth Date

Current Position (grade level, subject)

Prior teaching experience (subject, grade level, location, dates)

College(s) attended (insitution name, major/minor, graduation date)

Special area(s) of teaching expertise/interest

Why do you want to attend the Summer Agriculture Insitute
(additional pages welcome)

Names of relatives that are actively farming and location

Emergency contact person

Relationship Phone

Have you attended OSU or EOU since 1991?
Yes No If yes, which?

I grant permission to use my name, school, photos in which I might appear in and quotes for the promotion of SAI in future brochures and advertisements.
Yes No

I grant permission to duplicate lesson materials for future SAIs.
Yes No

Please mark which session(s) you would like to attend:
June 18-23, 2000 Oregon State University, Corvallis OR
July 31-August 4, 2000 Eastern Oregon University, LaGrande, OR

Questions are welcome!
Frances Hathaway OSU project coordinator
(541) 753-6547
frances@proaxis.com

Michele McLean EOU project coordinator
(541) 534-5125
mlm01@grh.org

Beth Knoble
(503) 399-1701
beth@oregonfb.org