Local Member Application

This form is for local families only

If you live in the Miami-Dade area and will attend our local events regularly, this form is for you. Please fill it out completely. Note that we only communicate with members via email, so make sure it is entered correctly.

If you are not a local family or only wish to participate in the Enrichment Program, what you are looking for is the distribution list we use to support the enrichment program. To join that, all you have to do is send email to: tel-enrichment-2009-2010+subscribe@googlegroups.com

* Required fields

Parents' Name(s)

* First * Last

* Address * City * Zip

* Area Code * Phone

* Email Address

Children's' Name(s)

First Last Age

Curriculum

Tell us a little about yourself. What do you hope to get from
the group and what would you like to add to the group?

Choose a Password
Password:

Confirm:

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