American Indian Pottery: Continuity and Tradition
Program Registration

Please use a separate form for each program requested.

Test Only 1: 2:

 * = Required Fields

Offered Monday–Friday mornings for Fall 2012.
Enter a first choice from the time slots above. Also enter a second choice in case your first date and time is not available.
	Date (mm/dd/yy)	Time
First choice:	*	*
Second choice:

Group Size: Minimum: 12**, Maximum: 28, minimum of 4 adult chaperones		*
** For smaller groups email us for special arrangements.
Cost***: $3.00 per student ($36.00 minimum) Chaperones and teachers are free.	$	*
PLEASE NOTE: A minimum 36 hour advance notice of cancellation is required to avoid a $36 late cancel fee. Call 621-9434 or 626-9172 to cancel. *** For information about needs-based discounts, call or email us.

Grade Level(s):	*
Name(s) of all Teacher(s) Coming: Teacher 1	*
Teacher 2
Teacher 3
No. of Chaperones: (minimum: 4 per class)	*
School Name:	*
School District:	*
School Address:	*
City, Zip:	*
School Phone:	*
School Fax:
Contact Name:	*
Day Phone:	*
Evening Phone:
Email:	*
Are your students working on any projects related to your visit? If yes, please explain.
Do your students or staff have any access-related concerns or requests? If yes, please explain.

Note: Your registration is not complete until you receive a confirmation from us.