Date of visit: Person(s) in charge:

Troop #: Girl Scout Level: Select One Daisies Brownies Juniors Cadettes Boy Scout Level: Select One Tigers Wolf Bears Webelos

Scheduled arrival time: Scheduled departure time:

Type of tour: Select One Standard Fieldtrip Recognition Workshop
If workshop, please select one: Girl Scouts Around the World People of the World Manners Puppets, Dolls & Plays Brownie Girl Scouts Around the World World Neighbors Traveler Global Awareness On My Way Humans & Habitats Girl Scouting Around the World ______________________________________________ Boy Scouts Games Around the World (Games, games, games) Masks Native American Life Let's Travel (Traveler)
Puppetry (ShowMan)

Worldways Children's Museum's Patches:
Quantity:   x   $1.25 each: $

Work phone: Home phone:

Mailing address:

City: State: Zip Code:

E-mail address:

Number of children: Adults: Ages/Grades:
Special needs, please specify:

Form of payment: Check Cash Charge Visa MasterCard Discover (please make checks payable to Worldways Children's Museum)

Credit card number: ________________________(for safety reasons please handwrite the card #)

Expiration date:______/______Your signature : ________________________

Deposit price based on your group size:

Select One 10-19 $25 deposit + $5 booking fee=$30 20-39 $50 deposit + $5 booking fee=$55 40-60 $75 deposit + $5 booking fee=$80 61-100 $100 deposit + $5 booking fee=$105