School or Group Request for Program Please complete and submit this form to start your request for a group visit and program. A member of our staff will then contact you to review your request and complete the reservation process.Please enable JavaScript in your browser to complete this form.Section 1: General InformationYour School or Group Name *Your Name (or Primary Contact for Group Visit) *FirstLastPrimary Contact Mobile Phone *This number will also be used as the primary contact number for the day of the group visitPrimary Contact Email *Section 2: Program SelectionPlease choose a program. We are happy to work with you to develop a program tailored to fit your needs. If this is something you're interested in, please choose Custom or Multi-Day Visit.Which program would you like to sign up for?1776: The American Revolution in the Champlain ValleyROV Shipwreck TourLake Ecology: PaddlingLake Ecology: RowingSelf-Guided VisitCustom or Multi-Day VisitCustom Program: Tell us what you are looking for *Please tell us about your group's needs and we'll be glad to create a custom program to meet your needs. Groups that exceed the normal maximum # of students, multi-day groups, and multiple programs on the same day are examples of custom programming. Would you like to add on the Lake History Introduction?Yes! (+$75)No thanks! (+$0)This is an optional 30-minute introduction run by staff for $75 to help your group get situated before their self-guided tour.Are you interested in learning more about Virtual Field Trips?Yes!No thanks!Section 3: Group and Visit InformationAt what grade level is your group? *How many students will attend? *How many adults will attend? *Will there be students with physical disabilities? If yes, please explain.How is your group getting to the Museum? *CarBusOtherOther: Please Explain *Do you plan to do anything else during your visit?We will eat lunch on the campus.We plan to visit the museum store.Is there anything else you'd like us to know about your group or your visit?Section 4: Preferred Dates and TimesPreferred Visit Dates Please indicate your top three preferred dates for this group visit. We will do our best to accommodate them in the order listed.Date - 1st Choice *Date - 2nd Choice *Date - 3rd ChoicePreferred Arrival & Departure Times Please tell us when you expect to arrive and when you need to depart. Arrival *Departure *Section 5: Billing InformationHow would you like pay? *Check, mailed to the MuseumCheck, paid on the day of your visitCash, paid on the day of your visitCredit card, paid on the day of your visitOther or combinationPlease Explain: Other or Combination Payment TypeBilling Contact's Email *Billing Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSection 6: Photography PermissionBy checking the box below you authorize the Lake Champlain Maritime Museum to photograph and/or videotape your students for publicity purposes. If you do not want your students to be photographed, please uncheck the box and submit the form.Photo PermissionI give permissionMessageSubmit
