Application to ICQ Science Teacher Users List

Participation in the list is totally FREE and you can change your information or delete it entirely at any time you choose.
This information will never be distributed to anyone who is not on the list.
The following information is necessary for me to process your application. It will be totally confidential and is used by myself, if I have a question about your application. Your confirmation that you have been added to the list will be sent to the address you provide in this section. This list is HAND maintained by me, personally, so ... it may take a week or more to process your request. Please, be patient.

Your full name:

Your email address: (e.g.: [email protected])

Information in this section will appear on the list exactly as you enter it.

List Name:

Link Type: (click to select)

Link URL:

ICQ Number:

What would you like other Science Teachers to know about you?

Information in this field will NOT appear on the list, but will be used to organize interschool projects and communications.

Position: (click to select)

Affiliation: (click to select)

School Name:

City/Town:

State/Prov.: Post./Zip Code:

Country:

Would you be interested in participating in online projects with other schools?  

Yes, I would
No, I wouldn't
I would like more information
Possibly in the future

Comments:

 

   
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