Cuba Program

at Burlington College

351 North Avenue Burlington, Vermont 05401 Phone: 802-923-2390 jcarter@burlington.edu

Visit our web site at:

CUBA FOR EDUCATION: THE VERMONT TEACHER’S EXCHANGE REGISTRATION

BURLINGTON.EDU/CLE

Upcoming professional development courses for Vermont teachers sponsored by the Burlington College Cuba Program are scheduled for the following dates: July 14-21, 2012 To register for the July trip you must complete this form and submit it along with a $300 deposit to Burlington College by May 1, 2012. Applications may be completed online or download a printable application form and send it along with the $300 deposit to the address below.

Name: Address: Phone: Email: School District: Grade level you teach: Subject(s) you teach:

Mail registration form to: Burlington College Cuba Program 351 North Avenue Burlington, Vermont 05401

Method of Payment
c Enclosed is my check payable to Burlington College. c Please charge the credit card. Credit Card Information: c Visa #: Signature: c MC c Discover c AmEx

Exp. Date: Code:

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