The Clay Center - Group Pre-Registration Form

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Group or School Name:
Contact Person:
County:
School Address:
City, State, Zip:
Work/School Phone:	() -Second partThird part
Alternate Phone Number:	() -Second partThird part
Best time to call:
Preferred contact method:	e-mail phone
E-mail:
Grade Level(s):	Pre-KK123456789101112Adult
Number of students:
Number of chaperones (1 for every 10 students):
Number of additional adults:
Due to limited availablility of certain programs, please indicate three dates your group would be interested in attending. Date you wish to visit:
First Choice:
Second Choice:
Third Choice:
Arrival Time (earliest):
Departure Time (latest):
Note: we allow 30 minutes for check-in:
Programs you wish to include:	Science Galleries (1 hour - recommended minimum) Planetarium show (1 hour) Giant Screen Film (1 hour) Workshop (1 hour) Docent Led Art Tour (30 minutes) Art Gallery (30 minutes) School Performance (1-2 hours) Science Demonstration (30 mins)
For menu information and/or to pre-order, call 304-561-3580 or email cafe@theclaycenter.org:
Lunch (30 minutes):	Pre-order box lunches with Embassy Suites Purchasing in Intermezzo Cafe Off-site Bringing own bag lunches
Transportation:	School Bus Cars Van Tour Bus Walking
Method of payment:	Cash Check Credit Card
Would you like to utilize Access Fund for my school group:	Yes
Special needs (how many and provisions needed):
Hearing impaired:
Sight Impaired:
Wheelchair accessible seating:
Other needs:
How did you hear about us?:	Education Brochure Website Previous Visit Clay Center Member Colleague Other

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