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Virtual Field Trip Request Form

* = required field

School/Organization Name

Address

Street Address

Street Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Contact Name

First

Last

Contact Phone Number (on day of program):

###

###

####

Contact Email Address

Number of Participants

Grade Level (if applicable)

Program Requested

Cuban Missile Crisis ($85)

Operation Code Cracker ($85)

Spy Science ($175)

Spy's Eye View (starting at $400)

The Secret History of History (starting at $150)

Spy School 101 ($85)

Date (1st choice)

MM

DD

YYYY

Time (1st choice) - Eastern Standard Time (EST)

Date (2nd choice)

MM

DD

YYYY

Time (2nd choice) - Eastern Standard Time (EST)

Program Delivery Mode

H.323 (Polycom, Cisco/Tanberg, LifeSize, etc)

Computer with webcam (Zoom)

IP address or ISDN number (if applicable):

Comments

Security Code *

Please enter the security code below.