Summer Information Form

CAN DO Project - EarthKAM Project

Member Information Sheet For Summer 1999

Name	-
Home Address	-

Home Phone	-
E-mail	-
School	-	Open in Summer ?	YES/NO (circle)
School Address	-
School Phone	-
School Fax	-
	THIS INFORMATION IS FOR THIS SUMMER ONLY
YOUR best summer address	-
	-
I can best be reached by	Web Site	E-mail	Phone
	http://www.musc.edu/cando/tlink/news.html	-	-

All information on this form will be kept private with one copy held here and one copy at Carol's Office. it will be strictly for CAN DO and EarthKAM Project use except as you may designate.

I am willing to share this information with other CAN DO Teachers:

If they request it? YES NO (circle one)
On the password secured CAN DO private website YES NO

Print this form out and fax it to: (843)-792-4157

Or mail it to : James H. Nicholson, CAN DO Project,MUSC Pathology Dept., 39 Sabin Street, Charleston, SC, 29406-5813