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Pronoun

Title

First Name

Last Name

Phone Number

Please note that you will be added to our mailing list. Your information will not be shared with third parties and will only be used for MineralsEd teacher updates and notices

Personal Email

*Some school districts have strong firewalls. Please include a personal e-mail as a back up.

School Name

School Street Address

City

Province

Postal Code

Number of Students

Grade Level

Number of Buses (if Applicable)

Will you be using any MineralsEd resources to supplement this activity?

How is this Field Trip relevant to your classroom?

This is a required field

Special Notes

Is there anything else we need to know i.e. accessibilty etc.

Please confirm that you have read all the important information stated above

I have read and understood. I am ready to submit my application.