TORCH WORKSHOP PARTICIPANT REGISTRATION FORM

Workshop title: ________________________________________________________________

Workshop facilitator(s):__________________________________________________________________

Workshop dates: ______________________________________________________________

Participant Name: _______________________________________________________________

Subject(s) taught: _______________________________________________________________

Grade(s) taught: _______________________________________________________________

Home Address: ______________________________________________________________________________

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School Address:

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Home phone number: ______________________________

School phone number: _______________________________

Email address: _________________________________________________________________

Date of registration: ________________________________

Participant signature: __________________________________ Date: __________________