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Bermuda Marine and Island Ecology Summer 2017 Course Application
Space is limited. Acceptance is at the discretion of the instructor. Please submit your application and deposit no later than December 12, 2016.
Student Information
First Name
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Last Name
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Date of Birth
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You must be at least 14.9 years old as of June 2017 to participate.
Email
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Home Phone
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Grade you will complete this year
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Why are you interested in taking this course?
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Parent Information
Parent/Guardian's Full Name
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Home Address
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Home Phone
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Mobile Phone
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Parent Full Name
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By checking this box, you are agreeing that your above typed name represents your signature.*
Parent Signature
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