Training/Order Form
(Please Print or Type)
1. Name: _____________________________________________________________
2. Address (where you would like further information to be sent):  School
 Home
School Name: _____________________________________________________________________
School/Home Address: _____________________________________________________________
City/State/Zip: ___________________________________________________________________
3. Phone: (home)
_____________________________________________________
(school) ______________________________________________________
(fax)
_____________________________________________________
4. Would you like to attend the training session:
Yes, Basic
Yes, Advanced
No
5. Members Manual (please check publication below and indicate how many needed)
 Poultry Chick Development Poster
Suggested all ages
(3.60 each) How Many? ________
 From Egg to Chick Leader Guide
(3.60 each)
How Many? ________
 Hatching Classroom Projects (This is a leader guide that includes student sheets and color posters.)
Suggested for ages 7 - 10 years
($4.90 each) How Many? ________
 Experiments in Poultry (This is a leader guide that includes student sheets and color posters.)
Suggested for ages 11 - 14 years
($4.90 each) How Many? ________
6. How many eggs would you like? (The poultry specialist conducting the training highly suggest that each
classroom have nothing less than 2 dozen eggs for a successful hatch. Prices include eggs and feed.)
 2 dozen ($10.00)  4 dozen ($20.00)
 6 dozen ($30.00)
 other:_________
7. Please check which location is best for you to pick up and drop off chicks.
Egg Pick Up Wednesday, April 17
Chick Drop Off Friday, May 11
 300 N. Elizabeth 7:30 a.m. – 4:00 p.m.
 300 N. Elizabeth 7:30 a.m.- 3:30 p.m.
th
 3807 W. 111 Street 7:30 a.m.– 4:00 p.m.
 3807 W. 111th Street 7:30 a.m. – 4:00 p.m.
Drop off, mail, or order online by March 16
University of Illinois Extension
Attn: Vera Hardy-Bolden
300 N. Elizabeth, Ste. 500C, Chicago, IL 60607
Fax # (312) 698-7090
*Please note that project enrollment is due Friday, March 16, 2007. There will be a $5 charge for orders
received after this date!
Publications will be available at the time of Egg Pick up.
If paying by check or money order make check payable to: University of Illinois Extension
University of Illinois • U.S. Department of Agriculture • Local Councils Cooperating.
University of Illinois Extension provides equal opportunity in program and employment.