Education Program Reservation

Print out this page, complete the form and mail it to:
Dunn County Historical Society, PO Box 437, Menomonie, WI   USA  54751

Teacher's Name _____________________________________________

School Name _______________________________________________

School Address ______________________________________________

School Phone ________________ Home Phone ___________________

E-Mail ___________________________________________

List your preferred dates and times:

1.  _________________________ at _________________________

2.  _________________________ at _________________________

3.  _________________________ at _________________________

Number of Students ___________   Grade Level _________________

Special needs, topic or other requests (Please be specific):