CYRM VC Registration - Smith - 11/17/10
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1. Program Fee Information

Orange County public schools
No Charge

Private and all out of county schools
$50.00 per interactive presentation

Out of state schools
$125.00 per interactive presentation

*
1. Name

Name

*
2. Grade Level

Grade Level

*
3. School Name

School Name

*
4. School District

School District

*
5. City

City

*
6. Program Choice (Orange County schools are given 1st priority for videoconferencing.)

Program Choice (Orange County schools are given 1st priority for videoconferencing.) Video Conference (Requires videoconferencing equipment)

Webcast

*
7. Email

*
8. Phone

Phone

*
9. Number of Students Participating

Number of Students Participating

CYRM VC Registration - Smith - 11/17/10Exit this survey >>

1. Program Fee Information

*1. Name

*2. Grade Level

*3. School Name

*4. School District

*5. City

*6. Program Choice (Orange County schools are given 1st priority for videoconferencing.)

*7. Email

*8. Phone

*9. Number of Students Participating