Summer Workshop Form - The Durham Museum : The Durham Museum

SUMMER FIELD TRIP FORM

"*" indicates required fields

School/Organization Name*

Address*

Main Contact Name*

First

Last

Phone for Main Contact*

Email for Main Contact*

Cell Phone for ‘Day of’ Contact*

"Day of' Contact Name (if different from Main Contact)

First

Last

Number of Students*

Grade Level*

Number of Teachers*

Number of Chaperones*

Is your group interested in purchasing items or snack packages from The Durham Museum’s Soda Fountain?

Yes (Additional details will be sent separately)

Date Requested*

Arrival Time Requested*

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

Do You Have Additional Information?

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