Outreach Booking

Name *

First

Last

Email *

Phone *

Alternate Phone

School Name *

School Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Number of Students *

Number of Classes *

Grade Level(s) *

Program Selection *Little Life and Lessons (Pre-K - 2nd Grades)Stories of Survival (3rd - 5th Grades)Expanding and Colliding (6th - 8th Grades)The European-Native American Melting Pot (9th - 12th Grades)

Add-ons *

• Games $2
• Talking Sticks $6
• Storytelling $2
• Corn Husk Dolls $4
• Beading $4
• None
• Pottery $4

First Choice Program Date *

Date

Time

Second Choice Program Date *

Date

Time

Program End Time *

Is there anything else you would like us to know?

Phone

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