CHEF REGISTRATION FORM

Please fill out the Chef Registration form below:
Today's Date*

MonthDayYear
Full Name*

First NameLast Name
Organization/Restaurant*
Title*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email*
Phone Number*

Area CodePhone Number
Website
Facebook Page
Twitter Page
Additional Information
Best form of communciation*

PhoneMobileEmailText
Are you a member of Slow Food East End?*

YesNo
If YES, please enter the name and email address registered under
If NO, click here to become a Slow Food Member. Please designate NY - East End (Long Island) a your chapter affiliation.
Culinary Association affiliation*
Professional certification(s) held*
Highest educational degree earned*

High School Graduate or lessAssociate degreeDegree/certificate programBachelor's degreePost graduate degreeOther
Do you hold a food handler's permit?*

YesNo
Previous school or culinary teaching experience*
What is your time commitment to the program?*
Example: October 15, 2014 until March 15, 2015
Preferred days?*

MondayTuesdayWednesdayThursdayFriday
How often can you participate?*

DailyWeeklyBi-weeklyMonthly
Areas of interest*

GardeningCooking Demonstrations: In ClassroomCooking Demonstrations: In CafeteriaIn classroom education about healthy eating or cookingIdeas for menu and recipe developmentOther
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