Instructor: ______ Angler Education

Instructor: ______ Angler Education

<p> STATE OF WATER VIDEO SCREENING PARTICIPANT SIGN-IN </p><p>Video Title: Vol. 1 State of Water Vol. 2 Finding A Balance Vol. 3 Springs Vol. 4 Flowing Water Vol. 5 Gulf Event Coordinator: ______Event Coordinator Signature: ______Event Coordinator Vol Hrs: Date Signed: Event Date: Event Location (Facility Name): ______City: ______Facility Type: City/Community/County Park Church/Rel Bldg Community/Public Bldg College/Univ Museum Nature/Env Edu Ctr School/ISD Site Scout Facility/Youth Camp TPWD Site or Park Zoo Other Ethnicity (circle one) Name Email Gender Youth or AS-Asian; AI-American Indian/Alaska Native; Provide your email address to receive free updates from Texas Parks M / F Adult B-Black/African American; (Please Print) Ha-Hawaiian/Pacific Islander; Hi-Hispanic; and Wildlife Department. You many unsubscribe at any time. (circle (circle O-Other; W-White one) one)</p><p>1 M F Y A AS AI B Ha Hi O W</p><p>2 M F Y A AS AI B Ha Hi O W</p><p>3 M F Y A AS AI B Ha Hi O W</p><p>4 M F Y A AS AI B Ha Hi O W</p><p>5 M F Y A AS AI B Ha Hi O W</p><p>6 M F Y A AS AI B Ha Hi O W</p><p>7 M F Y A AS AI B Ha Hi O W</p><p>8 M F Y A AS AI B Ha Hi O W</p><p>9 M F Y A AS AI B Ha Hi O W</p><p>10 M F Y A AS AI B Ha Hi O W</p><p>11 M F Y A AS AI B Ha Hi O W</p><p>12 M F Y A AS AI B Ha Hi O W</p><p>13 M F Y A AS AI B Ha Hi O W</p><p>14 M F Y A AS AI B Ha Hi O W</p><p>15 M F Y A AS AI B Ha Hi O W Totals: Event Date: Event Location (Facility Name): ______City: ______</p><p>Hours Assistant Event Coordinators / Check if Email Address Signature worked Volunteer Name: TPWD Phone Number (including (Please print) (required) (Please print) employee prep & wrap-up) ( ) -</p><p>Please return completed forms by email, fax, or mail to:</p><p>Aquatic Education Texas Parks and Wildlife Department 4200 Smith School Road Austin TX 78744</p><p>Email: education@tpwd.state.tx.us Fax: 512-389-8673</p>

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