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<HTML>
<HEAD>
<BASE HREF="http://www.mda.state.mn.us/docs/mktg/maitc/matrlfrm.htm">
<TITLE>MAITC Materials Order Form</TITLE>
</HEAD>
<BODY BGCOLOR="#FFFFFF">
<CENTER><TABLE BORDER="0" ALIGN="center" WIDTH="600">
<TR>
<TD ALIGN="CENTER" VALIGN="TOP">Minnesota Ag in the Classroom<BR>
90 West Plato Boulevard, St. Paul, MN 55107<BR>
Phone: 651-296-6688 &#149; Fax: 651-296-6890<BR>
<P><B><FONT SIZE="+1">Free Materials Order Form</FONT></B></P>
<P ALIGN="left"><B>* Denotes required fields</B></P>
<FORM METHOD="POST" ACTION="http://www.mda.state.mn.us/scripts/polyform.dll/MAITC">
<TABLE BORDER="0" ALIGN="DEFAULT" WIDTH="600">
<TR>
<TD><B>*Name:</B></TD>
<TD>
<INPUT TYPE="TEXT" NAME="~Name" SIZE="50">
</TD>
</TR>
<TR>
<TD><B>*Street Address 1: </B>
</TD>
<TD>
<INPUT NAME="~Address 1" SIZE="50" TYPE="TEXT">
</TD>
</TR>
<TR>
<TD>Street Address 2:</TD>
<TD>
<INPUT NAME="Address 2" SIZE="50" TYPE="TEXT">
</TD>
</TR>
<TR>
<TD><B>*City:</B></TD>
<TD>
<INPUT NAME="~City" SIZE="40" TYPE="TEXT">
</TD>
</TR>
<TR>
<TD><B>*State:</B></TD>
<TD>
<SELECT NAME="~State">
<OPTION VALUE="Alabama">AL</OPTION>
<OPTION VALUE="Alaska">AK</OPTION>
<OPTION VALUE="Arkansas">AR</OPTION>
<OPTION VALUE="American Samoa">AS</OPTION>
<OPTION VALUE="Arizona">AZ</OPTION>
<OPTION VALUE="California">CA</OPTION>
<OPTION VALUE="Colorado">CO</OPTION>
<OPTION VALUE="Connecticut">CT</OPTION>
<OPTION VALUE="District of Columbia">DC</OPTION>
<OPTION VALUE="Delaware">DE</OPTION>
<OPTION VALUE="Florida">FL</OPTION>
<OPTION VALUE="Federated States of Micronesia">FM</OPTION>
<OPTION VALUE="Georgia">GA</OPTION>
<OPTION VALUE="Guam">GU</OPTION>
<OPTION VALUE="Hawaii">HI</OPTION>
<OPTION VALUE="Iowa">IA</OPTION>
<OPTION VALUE="Idaho">ID</OPTION>
<OPTION VALUE="Illinois">IL</OPTION>
<OPTION VALUE="Indiana">IN</OPTION>
<OPTION VALUE="Kansas">KS</OPTION>
<OPTION VALUE="Kentucky">KY</OPTION>
<OPTION VALUE="Louisiana">LA</OPTION>
<OPTION VALUE="Massachusetts">MA</OPTION>
<OPTION VALUE="Maryland">MD</OPTION>
<OPTION VALUE="Maine">ME</OPTION>
<OPTION VALUE="Marshall Islands">MH</OPTION>
<OPTION VALUE="Michigan">MI</OPTION>
<OPTION VALUE="Minnesota" SELECTED>MN</OPTION>
<OPTION VALUE="Mississippi">MS</OPTION>
<OPTION VALUE="Missouri">MO</OPTION>
<OPTION VALUE="Northern Mariana Islands">MP</OPTION>
<OPTION VALUE="Montana">MT</OPTION>
<OPTION VALUE="North Carolina">NC</OPTION>
<OPTION VALUE="North Dakota">ND</OPTION>
<OPTION VALUE="Nebraska">NE</OPTION>
<OPTION VALUE="New Hampshire">NH</OPTION>
<OPTION VALUE="New Jersey">NJ</OPTION>
<OPTION VALUE="New Mexico">NM</OPTION>
<OPTION VALUE="Nevada">NV</OPTION>
<OPTION VALUE="New York">NY</OPTION>
<OPTION VALUE="Ohio">OH</OPTION>
<OPTION VALUE="Oklahoma">OK</OPTION>
<OPTION VALUE="Oregon">OR</OPTION>
<OPTION VALUE="Pennsylvania">PA</OPTION>
<OPTION VALUE="Puerto Rico">PR</OPTION>
<OPTION VALUE="Palau">PW</OPTION>
<OPTION VALUE="Rhode Island">RI</OPTION>
<OPTION VALUE="South Carolina">SC</OPTION>
<OPTION VALUE="South Dakota">SD</OPTION>
<OPTION VALUE="Tennessee">TN</OPTION>
<OPTION VALUE="Texas">TX</OPTION>
<OPTION VALUE="Utah">UT</OPTION>
<OPTION VALUE="Virginia">VA</OPTION>
<OPTION VALUE="Virgin Islands">VI</OPTION>
<OPTION VALUE="Vermont">VT</OPTION>
<OPTION VALUE="Washington">WA</OPTION>
<OPTION VALUE="Wisconsin">WI</OPTION>
<OPTION VALUE="West Virginia">WV</OPTION>
<OPTION VALUE="Wyoming">WY</OPTION>
</SELECT>
</TD>
</TR>
<TR>
<TD><B>*Zip Code:</B></TD>
<TD>
<INPUT TYPE="TEXT" NAME="~Zip" SIZE="10">
</TD>
</TR>
<TR>
<TD>Phone:</TD>
<TD>
<INPUT TYPE="TEXT" NAME="Phone" SIZE="12">
</TD>
</TR>
<TR>
<TD>Fax:</TD>
<TD>
<INPUT TYPE="TEXT" NAME="Fax" SIZE="12">
</TD>
</TR>
<TR>
<TD>Email:</TD>
<TD>
<INPUT TYPE="TEXT" NAME="Email" SIZE="60">
</TD>
</TR>
<TR>
<TD COLSPAN="2">
<HR SIZE="1" NOSHADE>
<B>School Information (if ordering for school delivery):</B></TD>
</TR>
<TR>
<TD>School Name:</TD>
<TD>
<INPUT TYPE="TEXT" NAME="School Name" SIZE="50">
</TD>
</TR>
<TR>
<TD>Street Address 1: </TD>
<TD>
<INPUT NAME="School Address 1" SIZE="50" TYPE="TEXT">
</TD>
</TR>
<TR>
<TD>Street Address 2:</TD>
<TD>
<INPUT NAME="School Address 2" SIZE="50" TYPE="TEXT">
</TD>
</TR>
<TR>
<TD>City:</TD>
<TD>
<INPUT NAME="School City" SIZE="40" TYPE="TEXT">
</TD>
</TR>
<TR>
<TD>State:</TD>
<TD>
<SELECT NAME="School State">
<OPTION VALUE="Alabama">AL</OPTION>
<OPTION VALUE="Alaska">AK</OPTION>
<OPTION VALUE="Arkansas">AR</OPTION>
<OPTION VALUE="American Samoa">AS</OPTION>
<OPTION VALUE="Arizona">AZ</OPTION>
<OPTION VALUE="California">CA</OPTION>
<OPTION VALUE="Colorado">CO</OPTION>
<OPTION VALUE="Connecticut">CT</OPTION>
<OPTION VALUE="District of Columbia">DC</OPTION>
<OPTION VALUE="Delaware">DE</OPTION>
<OPTION VALUE="Florida">FL</OPTION>
<OPTION VALUE="Federated States of Micronesia">FM</OPTION>
<OPTION VALUE="Georgia">GA</OPTION>
<OPTION VALUE="Guam">GU</OPTION>
<OPTION VALUE="Hawaii">HI</OPTION>
<OPTION VALUE="Iowa">IA</OPTION>
<OPTION VALUE="Idaho">ID</OPTION>
<OPTION VALUE="Illinois">IL</OPTION>
<OPTION VALUE="Indiana">IN</OPTION>
<OPTION VALUE="Kansas">KS</OPTION>
<OPTION VALUE="Kentucky">KY</OPTION>
<OPTION VALUE="Louisiana">LA</OPTION>
<OPTION VALUE="Massachusetts">MA</OPTION>
<OPTION VALUE="Maryland">MD</OPTION>
<OPTION VALUE="Maine">ME</OPTION>
<OPTION VALUE="Marshall Islands">MH</OPTION>
<OPTION VALUE="Michigan">MI</OPTION>
<OPTION VALUE="Minnesota" SELECTED>MN</OPTION>
<OPTION VALUE="Mississippi">MS</OPTION>
<OPTION VALUE="Missouri">MO</OPTION>
<OPTION VALUE="Northern Mariana Islands">MP</OPTION>
<OPTION VALUE="Montana">MT</OPTION>
<OPTION VALUE="North Carolina">NC</OPTION>
<OPTION VALUE="North Dakota">ND</OPTION>
<OPTION VALUE="Nebraska">NE</OPTION>
<OPTION VALUE="New Hampshire">NH</OPTION>
<OPTION VALUE="New Jersey">NJ</OPTION>
<OPTION VALUE="New Mexico">NM</OPTION>
<OPTION VALUE="Nevada">NV</OPTION>
<OPTION VALUE="New York">NY</OPTION>
<OPTION VALUE="Ohio">OH</OPTION>
<OPTION VALUE="Oklahoma">OK</OPTION>
<OPTION VALUE="Oregon">OR</OPTION>
<OPTION VALUE="Pennsylvania">PA</OPTION>
<OPTION VALUE="Puerto Rico">PR</OPTION>
<OPTION VALUE="Palau">PW</OPTION>
<OPTION VALUE="Rhode Island">RI</OPTION>
<OPTION VALUE="South Carolina">SC</OPTION>
<OPTION VALUE="South Dakota">SD</OPTION>
<OPTION VALUE="Tennessee">TN</OPTION>
<OPTION VALUE="Texas">TX</OPTION>
<OPTION VALUE="Utah">UT</OPTION>
<OPTION VALUE="Virginia">VA</OPTION>
<OPTION VALUE="Virgin Islands">VI</OPTION>
<OPTION VALUE="Vermont">VT</OPTION>
<OPTION VALUE="Washington">WA</OPTION>
<OPTION VALUE="Wisconsin">WI</OPTION>
<OPTION VALUE="West Virginia">WV</OPTION>
<OPTION VALUE="Wyoming">WY</OPTION>
</SELECT>
</TD>
</TR>
<TR>
<TD>Zip Code:</TD>
<TD>
<INPUT TYPE="TEXT" NAME="School Zip" SIZE="10">
</TD>
</TR>
<TR>
<TD>School Phone:</TD>
<TD>
<INPUT TYPE="TEXT" NAME="School Phone" SIZE="12">
Room Extension:
<INPUT TYPE="TEXT" NAME="Room" SIZE="6">
</TD>
</TR>
</TABLE>
<TABLE BORDER="0" ALIGN="DEFAULT" WIDTH="600">
<TR>
<TD VALIGN="TOP">
<INPUT TYPE="checkbox" NAME="Put me on the AgMag Mailing List" VALUE="Yes">
</TD>
<TD COLSPAN="2"><FONT SIZE="-1">Put me on your mailing list for the AgMag and Teacher Guide Series. (I know it's geared for upper elementary grade students (4-6) and teachers and is currently sent free to schools.)</FONT></TD>
</TR>
<TR>
<TD></TD>
<TD>
<INPUT TYPE="checkbox" NAME="Reference Copy" VALUE="Yes">
</TD>
<TD><FONT SIZE="-1">Reference copy for myself sent to home or business address</FONT></TD>
</TR>
<TR>
<TD></TD>
<TD>
<INPUT TYPE="checkbox" NAME="Classroom copy" VALUE="Yes">
</TD>
<TD><FONT SIZE="-1">For my classroom (Grade:
</FONT>
<INPUT TYPE="TEXT" NAME="Classroom copies for grade" SIZE="5">
&#149; <FONT SIZE="-1">
Quantity:
</FONT>
<INPUT TYPE="TEXT" NAME="Number of copies for classroom" SIZE="3">
<FONT SIZE="-1">
)</FONT>
</TD>
</TR>
<TR>
<TD ALIGN="CENTER" COLSPAN="3" BGCOLOR="Silver"><FONT SIZE="-1">NOTE: If you are already on our school list, you'll continue to receive mailings this next school year.</FONT>
</TD>
</TR>
<TR>
<TD VALIGN="TOP">
<P>&nbsp;</P>
<P>
<INPUT TYPE="checkbox" NAME="Agtivity books" VALUE="Yes">
</P>
</TD>
<TD COLSPAN="2">
<P>&nbsp;</P>
<P><FONT SIZE="-1">Ag-tivity Books. Master copy for the teacher (not for each student) . . . many reproducibles.</FONT><BR>
<INPUT TYPE="checkbox" NAME="K-3 Agtivity Book" VALUE="Yes">
<FONT SIZE="-1">
K-3
&#149;
</FONT>
<INPUT TYPE="checkbox" NAME="4-6 Agtivity book" VALUE="Yes">
<FONT SIZE="-1">
4-6 &#149;
</FONT>
<INPUT TYPE="checkbox" NAME="Secondary Agtivity Book" VALUE="Yes">
<FONT SIZE="-1">
Secondary</FONT>
</P>
</TD>
</TR>
<TR>
<TD>
<INPUT TYPE="checkbox" NAME="MAITC brochure" VALUE="Yes">
</TD>
<TD COLSPAN="2"><FONT SIZE="-1">Minnesota Ag in the Classroom Brochure</FONT></TD>
</TR>
<TR>
<TD>
<INPUT TYPE="checkbox" NAME="Sample AgMag series" VALUE="Yes">
</TD>
<TD COLSPAN="2"><FONT SIZE="-1">Sample Student AgMag Series</FONT></TD>
</TR>
<TR>
<TD>
<INPUT TYPE="checkbox" NAME="Minigrant application" VALUE="Yes">
</TD>
<TD COLSPAN="2"><FONT SIZE="-1">M-AITC Minigrant Program application for practicing K-12 teachers</FONT></TD>
</TR>
<TR>
<TD>
<INPUT TYPE="checkbox" NAME="Commodity Cards" VALUE="Yes">
</TD>
<TD COLSPAN="2"><FONT SIZE="-1">17 Commodity Cards &#151;
</FONT>
<INPUT TYPE="checkbox" NAME="Master set of commodity cards" VALUE="Yes">
<FONT SIZE="-1">
Master Set &#149;
</FONT>
<INPUT TYPE="checkbox" NAME="Student set of commodity cards" VALUE="Yes">
<FONT SIZE="-1">
Student Set (black &amp; white)</FONT>
</TD>
</TR>
<TR>
<TD>
<INPUT TYPE="checkbox" NAME="Concept Matrix series" VALUE="Yes">
</TD>
<TD COLSPAN="2"><FONT SIZE="-1">Concept Matrix Series &#151;
</FONT>
<INPUT TYPE="checkbox" NAME="K-4 matrix series" VALUE="Yes">
<FONT SIZE="-1">
K-4 &#149;
</FONT>
<INPUT TYPE="checkbox" NAME="5-8 matrix series" VALUE="Yes">
<FONT SIZE="-1">
5-8 &#149;
</FONT>
<INPUT TYPE="checkbox" NAME="9-12 matrix series" VALUE="Yes">
<FONT SIZE="-1">
9-12</FONT>
</TD>
</TR>
<TR>
<TD>
<INPUT TYPE="checkbox" NAME="Ag Literacy Framework" VALUE="Yes">
</TD>
<TD COLSPAN="2"><FONT SIZE="-1">National K-12 Ag Literacy Framework</FONT></TD>
</TR>
<TR>
<TD>
<INPUT TYPE="checkbox" NAME="Suggested Reading List" VALUE="Yes">
</TD>
<TD COLSPAN="2"><FONT SIZE="-1">Suggested Reading List</FONT></TD>
</TR>
<TR>
<TD>
<INPUT TYPE="checkbox" NAME="Field Trip Guide" VALUE="Yes">
</TD>
<TD COLSPAN="2"><FONT SIZE="-1">Field Trip Guide for teachers and other youth leaders</FONT></TD>
</TR>
<TR>
<TD>
<INPUT TYPE="checkbox" NAME="Minnesota Ag Profile" VALUE="Yes">
</TD>
<TD COLSPAN="2"><FONT SIZE="-1">Minnesota Agricultural Profile (color brochure)</FONT></TD>
</TR>
<TR>
<TD>
<INPUT TYPE="checkbox" NAME="Science and Ag booklet" VALUE="Yes">
</TD>
<TD COLSPAN="2"><FONT SIZE="-1">Science and Agriculture booklet</FONT></TD>
</TR>
<TR>
<TD>
<INPUT TYPE="checkbox" NAME="Map and Placemat" VALUE="Yes">
</TD>
<TD COLSPAN="2"><FONT SIZE="-1">Product Map and Fun Facts Placemat</FONT></TD>
</TR>
<TR>
<TD>
<INPUT TYPE="checkbox" NAME="Food Guide Pyramid" VALUE="Yes">
</TD>
<TD COLSPAN="2"><FONT SIZE="-1">Food Guide Pyramid</FONT></TD>
</TR>
<TR>
<TD>
<INPUT TYPE="checkbox" NAME="Minnesota Ag Stats Book" VALUE="Yes">
</TD>
<TD COLSPAN="2"><FONT SIZE="-1">Minnesota Agriculture Statistics Book</FONT></TD>
</TR>
<TR>
<TD>
<INPUT TYPE="checkbox" NAME="Minnesota Resource Guide" VALUE="Yes">
</TD>
<TD COLSPAN="2"><FONT SIZE="-1">Minnesota Educational Resource Guide</FONT></TD>
</TR>
<TR>
<TD>
<INPUT TYPE="checkbox" NAME="USDA Resource Guide" VALUE="Yes">
</TD>
<TD COLSPAN="2"><FONT SIZE="-1">USDA Educational Resource Guide</FONT></TD>
</TR>
<TR>
<TD>
<INPUT TYPE="checkbox" NAME="Tech Watch Video" VALUE="Yes">
</TD>
<TD COLSPAN="2"><FONT SIZE="-1">Video - &quot;Tech Watch&quot; for grades 6-10 Science and Careers</FONT></TD>
</TR>
<TR>
<TD>
<INPUT TYPE="checkbox" NAME="Time Travels Video" VALUE="Yes">
</TD>
<TD COLSPAN="2"><FONT SIZE="-1">Video - &quot;Time Travels&quot; for grade 4-8 Social Studies</FONT></TD>
</TR>
<TR>
<TD>
<INPUT TYPE="checkbox" NAME="Bookmarks" VALUE="Yes">
</TD>
<TD COLSPAN="2"><FONT SIZE="-1">Student Bookmarks &#151;
</FONT>
<INPUT TYPE="TEXT" NAME="Number of Bookmarks needed" SIZE="3">
<FONT SIZE="-1">
Quantity</FONT>
</TD>
</TR>
<TR>
<TD>
<INPUT TYPE="checkbox" NAME="Byproducts brochure" VALUE="Yes">
</TD>
<TD COLSPAN="2"><FONT SIZE="-1">Agriculture . . . More than Breakfast, Lunch and Dinner (by-products brochure)</FONT></TD>
</TR>
<TR>
<TD>
<INPUT TYPE="checkbox" NAME="Directory of Assns and Orgs" VALUE="Yes">
</TD>
<TD COLSPAN="2"><FONT SIZE="-1">Directory of Producer Associations and Agricultural Organizations</FONT></TD>
</TR>
<TR>
<TD>
<INPUT TYPE="checkbox" NAME="Performance Packages" VALUE="Yes">
</TD>
<TD COLSPAN="2"><FONT SIZE="-1">Performance Packages &#151;
</FONT>
<INPUT TYPE="checkbox" NAME="All perf pkgs" VALUE="Yes">
<FONT SIZE="-1">
All 12 &#149;
</FONT>
<INPUT TYPE="checkbox" NAME="Primary perf pkgs" VALUE="Yes">
<FONT SIZE="-1">
Primary &#149;
</FONT>
<INPUT TYPE="checkbox" NAME="Intermediate perf pkgs" VALUE="Yes">
<FONT SIZE="-1">
Inter &#149;
</FONT>
<INPUT TYPE="checkbox" NAME="Middle perf pkgs" VALUE="Yes">
<FONT SIZE="-1">
Middle &#149;
</FONT>
<INPUT TYPE="checkbox" NAME="High School perf pkgs" VALUE="Yes">
<FONT SIZE="-1">
High</FONT>
</TD>
</TR>
<TR>
<TD>
<INPUT TYPE="checkbox" NAME="Shopping Cart booklet" VALUE="Yes">
</TD>
<TD COLSPAN="2"><FONT SIZE="-1">Science in Your Shopping Cart (booklet for teachers)</FONT></TD>
</TR>
<TR>
<TD>
<INPUT TYPE="checkbox" NAME="Farm Facts" VALUE="Yes">
</TD>
<TD COLSPAN="2"><FONT SIZE="-1">Farm Facts (U.S. information)</FONT></TD>
</TR>
<TR>
<TD VALIGN="TOP">
<INPUT TYPE="checkbox" NAME="Ag map set" VALUE="Yes">
</TD>
<TD COLSPAN="2"><FONT SIZE="-1">Geography of Minnesota Agriculture map set </FONT><BR>
<INPUT TYPE="TEXT" NAME="Grade level" SIZE="6">
<FONT SIZE="-1">
Grade Level &#149;
</FONT>
<INPUT TYPE="TEXT" NAME="Number of maps needed" SIZE="3">
<FONT SIZE="-1">
Number of Student Desk Maps &#149;
</FONT>
<INPUT TYPE="TEXT" NAME="Number of Tguides needed" SIZE="3">
<FONT SIZE="-1">
Number of Teacher Guides</FONT>
</TD>
</TR>
</TABLE>
<P>
<INPUT TYPE="SUBMIT" NAME="Submit" VALUE="Submit to M-AITC">
<FONT COLOR="White">. . .</FONT>
<INPUT TYPE="RESET" NAME="Reset" VALUE="Reset Form">
</P>
</FORM>
<P>&nbsp;</P>
For more educational resources check out <A HREF="http://www.learnagriculture.org">LearnAgriculture</A></TD>
</TR>
</TABLE></CENTER>
</BODY>
</HTML>