Program Enrollment Form

Your Information

Name
What grade do you teach?
Total number of participating students (in your classes)
When would you like to receive the materials?

Note: Student enrollment will be verified before shipping to include any new students.

School Information

School Name
School Address
 
City
State  Zip 
School District

How can we reach you?

Phone  Ext 
Fax
E-mail Address

Additional Participating Teachers

Please enroll the following additional teachers to participate in the FREE Program.

1. Name        Number of Students  
2. Name        Number of Students  
3. Name        Number of Students  
4. Name        Number of Students  
5. Name        Number of Students  

By adjusting your thermostat to a warmer setting in summer (78 degrees) and cooler in winter (68 degrees) you could save up to $100 a year. Close your drapes and blinds during summer to keep the sun's rays out and open them in winter to let in warm sunlight.