Pre-registration information for
Sam Rhine Genetic Update Conference
For more information visit www.samrhine.com



Pre-register by e-mail or by fax
1.  E-mail - quickest way to pre-register:
E-mail information below, A thru K, to:  samrhine@aol.com
If you Pre-register by Email you will receive Confirmation by Email    
or 2.  Fax this form toll free to (888) 228-5921

If you Pre-register by Fax you will receive Confirmation by Fax

 Include the following information in your e mail or fax:

A.  Your School:

B.  Your School Address:

C.  City                              State            Zip

D.  School Phone w/ area code  (          )

E.  School Fax     w/ area code  (          )

F.  Conference Site:

G.  Conference Date:  January 24, 2008

H.  Number of Students Attending: _____

            Please do not pre-register 30 and arrive at the conference with 10!

Last year some students were needlessly turned away because

seats were reserved for students who did not show up!                  

I.   Number of Teachers Attending: _____ 

 

J.  Teachers Attending and their Email addresses:

         (Future conference invitations will be by Email; all email addresses are secure)

              Teacher’s Name(s)           Teacher’s Email address

1. 

2. 

3. 

4. 

   

 K.  'Teacher in Charge' name & home / cell phone for:

unexpected emergencies, delays, cancellations etc. - All Secure!

Name ___________________  Phone ____________________


Sam Rhine  -  Office Phone (800)727-2315 - Fax (888) 228-5921 - Cell (317) 439-7493

14000 East 113th Street, Fortville, IN  46040-9623   -   samrhine@aol.com



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