Summer Workshop Form - The Durham Museum : The Durham Museum

SATURDAY (4/18) HOURS (9AM-4PM) • Nebraska SciFest Expo (9AM-Noon, Free Admission with advanced ticket)

SUMMER FIELD TRIP FORM

School/Organization Name*
Address*
Main Contact Name*
First Last
Phone for Main Contact*
Email for Main Contact*
'Day of' Contact
Cell Phone for ‘Day of’ Contact*
"Day of' Contact Name (if different from Main Contact)
First Last
Participant Information
Number of Students*
Grade Level*
Number of Teachers*
Number of Chaperones*
Date Requested*
MM slash DD slash YYYY
Arrival Time Requested*

: Hours

Minutes

AM/PM
Field Trip Requested*
* Please choose one for each group of approximately 25 students.
- Heroes and Villains
- Platform and Play
- Build It Up!
- Pioneers on the Prairie
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