Registration Application for Exploring the Physical World
(Please print)

I and my child wish to register for the Exploring the Physical World ssessions of Science Saturdays that I have indicated below. I have completed the application and included my letter describing what I and my child hope to gain from participating. I am also enclosing a check for $15 if one session is selected, $20 for two sessions, or $30 for all three sessions, payable to the Wisconsin Initiative for Science Literacy.
 

____ Polymers (Feb 14)

____ How Does It Sound? (Feb 21)

____ Nanotechnology (Feb 28)

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

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

Name of child's school: _______________________________________________________

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

Address: __________________________________________________________________________
                               (street)

               __________________________________________________
                               (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.