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REQUEST A SCHOOL OR GROUP PROGRAM FORM
School or Organization Name
*
School or Organization Address
*
School Grade Level if Appropriate
*
Name
*
First Name
Last Name
Email
*
Phone
(###)
###
####
Number of Anticipated Participants
*
Event Location
At the Valpo Education Center
At your School
Other
If marked other then describe location here
Preferred Length of Educational Program:
*
30 minutes
1 hour
2 hour
Field Trip
Preferred Program Window:
Morning
Afternoon
After School
Please Select a Program:
*
Mammals of Indiana
Birds of Indiana
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I Would Like to Rent an Education Trunk to Accompany the Day
*
No
Yes
Additional Notes
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