EXHIBITION
Brought to you by Glencore
Education Program Booking Request Form PERC TUCKER REGIONAL GALLERY 29 MAY – 12 JULY 2015
CONTACT DETAILS School name: Address: Teacher name: Phone:
Mobile:
STUDENT DETAILS Primary (Activity books provided) Year Level: Secondary (Education resource and worksheets provided) Year Level: Number of teachers/supervisors:
Number of students:
OTHER: Special Requirements or Accessibility Requirements:
VISIT DETAILS Preference 1: Date: Time:
Preference 2:
Length of visit:
Date: Time:
EXHIBITION