Programme Registration Form

School:

* School Name

School Number

Delivery Address:

* Delivery Street

* Delivery Suburb

* Delivery City

Postal Address:

* PO Box / Street

* Postal Suburb

* Postal City

* Island (North / South)

Your Information

* Name

* Position

* Phone

Fax

* Email

Co-ordinators Information

Nominated Co-ordinators Name

Co-ordinators Usual Position

Co-ordinators e-mail address

Co-ordinators Contact Phone

I would like to participate in this Fundraising Initiative

No. of Students Involved

NB: Fundraising Booklets provided by the Trust FREE of charge

I would like my school to participate in this Teaching Unit

No. of Students Involved

No. of Teachers Involved

To receive copies of the Student Handbooks, please choose from one of the follwing two options :

(A)

I require colour printed copies of the Student Handbook @ $2 each

Total Copies of Student Handbooks to be purchased

- Student Handbooks will be couriered upon receipt of payment. Payment includes GST.

- Please note that courier charges are paid for by The Energy Smart Schools Trust.

or (B)

I require CD copy of the Student Handbook so that I can print the "Student Handbook" on my school printer or load onto my school network

- NB Teacher Guides are provided by the Trust at no charge. Teacher Guide also provided on the CD.

I require one of The Energy Smart Schools Trust Team to contact me regarding a FREE School Power Saver Assessment

I am interested in having the EcoBus visit our school

* Verify Verify

Comments

Thank you for your registration.

The Energy Smart Schools Trust will be in contact with you within 2 working days

Please read the Terms and Conditions information on this site prior to submitting your email confirmation.

I have read the Terms & Conditions