REGISTRATION

Green Initiatives in School Wellness Webinar

Presented by the USDA FNS Midwest Region
Tuesday, December 15, 2009
2:00pm - 3:30pm Central Standard Time

1) Registrant Information
First Name:
Last Name:
Title:
Agency / Organization:
Address:
Address:
City:
State:
Email Address:
Phone Number:

2) Please specify your job title or role as it relates to Local Wellness Policies:

If you selected other, please specify:

3) What do you hope to gain from participating in this webinar?

4) What topics would you like to see addressed in future webinars?

5) If you require any additional assistance, or should you have any special needs, please explain below.

Thank you for your registration! You will receive a confirmation email within 24-hours of the webinar. This email will include information on connecting to the webinar and the teleconference.

Should you have any questions about the webinar please contact:
Emily Buckham Buday
OSIPO Outreach Strategist
703-605-0772
emily.buckham@fns.usda.gov

First Name:
Last Name:
Title:
Agency / Organization:
Address:
Address:
City:
State:
Email Address:
Phone Number: