2022 Leadership Workshop Registration - Community Blood Center

School Name*

What Club/Organization Do You Represent?*

Workshop You Will Attend*

Teacher Name*

First Last

Teacher Email*

Enter Email Confirm Email

Teacher Shirt Size*

How many students will attend?*

Please enter a number from 1 to 10.

Student #1 Shirt Size

Student #2 Shirt Size

Student #3 Shirt Size

Student #4 Shirt Size

Student #5 Shirt Size

Student #6 Shirt Size

Student #7 Shirt Size

Student #8 Shirt Size

Student #9 Shirt Size

Student #10 Shirt Size

The Dickerson Park Zoo is offering a special discounted $5 admission for Springfield workshop attendees. You must use the admission ticket on September 21, after the workshop concludes. Is your group interested in visiting the Zoo?*

Yes
No

How many members of your group will visit the Zoo? (Payment due at workshop)*

Please enter a number from 1 to 11.