School/Organization:_________________________________________________

Address: ___________________ City: ___________________ State: _____ Zip: __________

Contact Person: _____________________________ E-Mail: __________________________

School Phone: ____________________ Contact Person Home Phone: ____________________

Please indicate your final number of students: Male______ Female______ chaperones: Male______ Female:______

Please indicate classes you are interested in scheduling:

First choices:___________________________________________________

Second choices: _________________________________________________

Evening Programs: _______________________________________________

What mode of transportation will you be using ( groups must have one vehicle on site
to transport participants to medical facilities in non-emergency situations – the Audubon
Center does not provide this type of transportation):_________________________________

Do any of the participants have a birthday during your stay? Please circle: Yes No

Do you want to have store time scheduled? Please circle: Yes No

Do you want the Audubon Center to provide evening snacks (fee of $.75/person per snack)?
Please circle: Yes No

To whom should the bill be sent? Payment is requested within thirty days after your visit.

Name:____________________________________ School:___________________________________________

Address:_______________________________ City:_________________________ State:______ Zip:_____________

PLEASE RETURN THIS FORM AT LEAST TWO MONTHS
BEFORE YOUR VISIT. THANKS!