EmailMe Form - Destination Ag Online Registration

Group and Contact Information

School Name *

Contact Person *

Phone *

### - ### - ####

Email *

preferred means of contact

Confirm

Group Address *

Street Address City State / Province / Region Postal / Zip Code 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. Virtual live-streaming experience is $45 for two lessons for up to four classrooms. 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 / DD / YYYY

Date of Visit (2nd choice)

MM / DD / YYYY

Used only if desired date is not available.

Further Information

Grade(s) *

Estimated # of Students *

# of Classes *

Group and Contact Information

Program Type

Program Date

Further Information

Museum staff will contact you to confirm program date and discuss further information.