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Destination Ag Program Booking Form
If you are from a public school in the following school districts and grade levels (PreK, 1st, 3rd, 5th; Ben Hill, Berrien, Brooks, Colquitt, Cook, Echols, Irwin, Lanier, Lowndes, Tift, Turner, Valdosta City, Worth), then your school may be included in the gift-funded program and already have a field trip scheduled. Confirm with your principal prior to completing this form.
Group and Contact Information
School Name
*
Contact Person
*
Phone
*
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Email
*
preferred means of contact
Confirm
Group Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
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El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
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Chile
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Peru
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Venezuela
Albania
Andorra
Armenia
Austria
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Cyprus
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Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
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India
Indonesia
Iran
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Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
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Laos
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Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
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Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
District
*
Program Type
Choose between on-site programing (school visits the Museum) or virtual (DA staff live-streaming into the classroom). Refer to DA Program Guide for program descriptions. On-site field experience cost is $7.00 per student (for non-gift funded districts). Virtual live-streaming experience is $45 for two lessons for up to four classrooms (for non-gift funded school districts). Additional lessons and classrooms may be available at an additional cost.
Programs
*
On-site field experience (have up to 4 sessions when visiting Museum)
Virtual live-streaming experience (have 2 lessons streamed live into your classroom)
Program Date
Desired Date of Program
MM
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DD
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YYYY
Date of Visit (2nd choice)
MM
/
DD
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YYYY
Used only if desired date is not available.
Further Information
Grade(s)
*
Estimated # of Students
*
# of Classes
*
Museum staff will contact you to confirm program date and discuss further information.