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Environmental Education Alliance of Georgia

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Our Story
- About EEA
  - About Our Organizational Members
  - About Our History
- About Env Ed
  - About Env Justice
  - About Env Stewardship
Our Team
Our Events
Our Resources
Our Work
Our News
Our Impact
JOIN or GIVE
Member Portal
- My Account
- Field Excursions
Contact Us
Outdoor Learning Store
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Susan's Test Page 2

2022 EEA Annual Conference Registration

* Indicates required field

Name *

First

Last

Email *

Comment *

Submit

* Indicates required field

Can you make it? *

Yes No Maybe

# of additional guests *

Email *

Name *

First

Last

Submit

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How did you hear about this site? *

Internet Search Advertisement Friend Other

If Other please specify: *

What is your age? *

Less than 13 13-18 19-25 26-35 36-50 Over 50 Prefer not to say

What is your household income? *

Less than $10,000 $10,001 - $25,000 $25,001 - $40,000 $40,001 - $70,000 $70,001 - $100,000 Greater than $100,000 Prefer not to say

Submit

Test Pollinator Habitat Certification Application

Applicant Information

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Name(s) to Appear on Certificate *

Organization Name *

Address of Pollinator Habitat *

Line 1

Line 2

City

State

Zip Code

Country

Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

Publicity

Would you like a press release sent to your local paper? *

Yes No

If yes, please list the name and email address of your local paper below:

Name of paper *

Email address of paper *

Habitat Description

Choose the option that best describes your habitat: *

Backyard Apartment of Rooftop Garden Workplace Farm Schoolyard Community Garden or Park Place of Worship

Choose the option that best describes your location: *

Urban Suburban Rural

List the approximate property size: *

Area *

List approximate percentage of property dedicated to pollinators: *

Briefly describe your project and how it benefits butterflies and other pollinators: *

For educational facilities, briefly describe how the project is incorporated into the curriculum: *

Food

Besides two species of milkweed (two plant minimum for each species) for monarchs, you must provide host plants for five additional butterfly species. List the scientific name of the plant, whether or not it is native to Georgia (or your state or region), and the common or scientific name of the butterfly species that uses it as a host. Some plants may be host to more than one species of Lepidoptera. Make sure that the species you list is a pollinator.

Milkweed plant #1 scientific name: *

Native? *

Yes No

Common or scientific name of butterfly species: *

Choose Any *

Option 1 Option 2 Option 3 4 8 5 6 7 9 10 11 12 13 14

Submit

ATEEG Professional Development Log

Contact Us

Environmental Education Alliance, Inc.
P.O. Box 801066 | Acworth, GA 30101

EEA does not does not discriminate on the basis of race, color, national origin, sex, age, or disability in its program , activities, or employment. For more information on EEA's non-discrimination commitment click here .
Grievance officer may be contacted at info@eealliance.org

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Our Story
- About EEA
  - About Our Organizational Members
  - About Our History
- About Env Ed
  - About Env Justice
  - About Env Stewardship
Our Team
Our Events
Our Resources
Our Work
Our News
Our Impact
JOIN or GIVE
Member Portal
- My Account
- Field Excursions
Contact Us
Outdoor Learning Store
PassTick2023-4