Education Program Request

Primary Contact Information

Organization Information

Educational Program Address

Program Information

Event Name: *
Event Date: *
Alternate Event Date: *
Set-Up Time:
Start Time: *
End Time: *
Program Type: *
Specify Program Type:
Number of Presentation(s):*
Length of Presentation: *
Type of Group: *
Age-Group/Grade-Level: Please note: For school groups, Liberty Education is happy to provide programs for FIRST GRADE classrooms and older. DUE TO TIME CONSTRAINTS, WE CANNOT CONDUCT PROGRAMS FOR KINDERGARTEN CLASSES. Please discuss other situations with the Program Coordinator who contacts you.
Expected Group Size: *
Major cross streets, driving directions, and other information we should have:

Donation(s)

Although donations are not required, we request that the donation amount at least be enough to cover the program expense. Donations may be in the form of cash, check, or supplies. To see a list of supplies that we need, click here.
Check to be mailed Aprox $
Pick up check at event . . $
Pick up supplies at event:
Public donations OK at event.
T-shirt sales OK at event.