Registration Decoding the Driftless
This form is for the purpose of collecting contact information for Driftless Area educators teaching grades 3-12 wishing to participate in free access to our highly awarded Driftless Region full length documentary film, lessons and related materials.  Please respond completely to the following questions.  

A copy of Decoding the Driftless on USB flash drive (two per school) will be shipped within 2-4 weeks of registration.  You will, additionally, receive an emailed link to six downloadable lessons correlated to the film.  We will use your school email address for all communications including additional opportunities and follow-up brief survey.

If you have any questions about this form you may contact Jan Wee, Education Outreach Coordinator, Sustainable Driftless, Inc. at sustainabledriftless.outreach@gmail.com for a prompt answer.  
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Email *
View from the Driftless Region of the Upper Mississippi River Valley
First Name *
Last Name *
School Name *
Full School Mailing Street Address *
P.O. Box (if appropriate)
City *
State *
Zip Code *
County (please add the county where your school is located) *
School Telephone Number including area code *
Grade or Grades Taught  (check all that apply) *
Required
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Subjects Taught *
Have you viewed the film Decoding the Driftless in the past? Where? *
Any comments or questions?  I will do my best to respond in the days ahead.  Thank you for registering!  Encourage your fellow educators at your school to register or educators from Driftless Region schools.  We appreciate your interest and your desire to bring our film and lessons to your students! - Jan, Education Outreach Coordinator - Sustainable Driftless, Inc.
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