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REDISCOVER THE MISSISSIPPI: 3 DAY RIVER EXPEDITION
The Basics... Why are we asking for so much information?

*First/Last Name:
Home Email:
*Work Email:
*Home Address:
*City:
*State:
*Zip:
County:
Home Phone:
School/Organization/Agency:
Work Address:
Work City:
Work State:
Work Zip:
Work Phone:


Professional Development...
Please check if you:
Would like graduate credit for taking this workshop
Would like recertification credits for attending this workshop
Would like professional development credits for attending this workshop
I am a licensed teacher in state.


Grub...
All breakfast, lunch and one dinner will be arranged by LL&W. A light breakfast will be served daily around 8am and will consist of coffee, juice, fruit, granola bars, muffins, etc. Lunch will usually consist of deli-style sandwiches, chips, pop, etc. Dinner will be a cook-out of various river fish and vegetation. At all ports we overnight in, there are dinner places nearby.
I'll eat whatever you provide
I prefer vegetarian meals
I have specified dietetic needs. Please explain:

Sleeping Accommodations...
LL&W will make all overnight arrangements and reservations for the nights of July 16, 17, and 18th. However, it will be your responsibility to pay for your room upon arrival. We are getting a group rate, discounting the fee. Due to the likelihood of extreme heat (it is July in the Midwest!) and logistical issues, we are not providing a camping option. More details on how to reserve a room will be provided after registration form is received by LL&W.


WHERE?

July 29 - New Botson/Keithsbury, IL Area (Exact lodging TBA)
July 30 - Muscantine, IA (Exact lodging TBA)

WITH WHO?
(After the workshop is full, I will match up roommates and notify you prior to the workshop who your roomie will be for the trip.)

I wish to lodge with a friend/co-worker.
Roommate name:

I don't know anyone else attending. Please find me a roommate.
Male Female

I wish to have private lodging (Note: You will be responsible for the extra room rates)

Emergency Contact info...
In case of an emergency, please contact:
Name:
Address:
Primary Phone:
Secondary Phone:
Relationship:
   



Other...
Where did you hear about the workshops?
Choose one of the following from the pulldown menu.


Professional Connection to the River:

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Is this the first LL&W Big River Educational Workshop you have attended?
yes No

If no, can you list the location or year of all past workshops you have attended?

Questions/Comments

*NOTE: Due to Coast Guard regulations, Living Lands & Waters can NOT accept any money as a fee or donation for the workshop.

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