Pacific Historic Parks Presentation Request Form: Pearl Harbor National Memorial
I read and understand the Pacific Historic Parks Field Trip and Presentation Request Guide *
Required
I understand that this request is not final until it has been confirmed by the Pacific Historic Parks Education Department. *
Required
By submitting this form, I am inviting a Pacific Historic Parks representative to come to my school, learning center, or community to give a 45-60 minute presentation according to the selected education program. *
Required
Name of School / Educational Institute / Community Site *
Provide the name of your School, Educational Institute, or Community Site
Your answer
Teacher / Community Leader's Name (Point of Contact) *
Provide the name of the point of contact and who will be present at the Presentation
Your answer
Name of Secondary Contacts *
Provide the name(s) of additional adults who will be present at the Presentation
Your answer
Point of Contact Teacher / Community Leader Email Address *
State your email address
Your answer
Email Addresses of Secondary Contacts
State email addresses of additional adults who will be present at the Presentation
Your answer
Point of Contact Teacher / Community Leader Phone Number *
Provide a phone number to contact you
Your answer
Phone Numbers of Secondary Contacts *
Provide phone numbers of additional adults who will be present at the Presentation
Your answer
Physical Location and/or Address of School / Educational Institute / Community Site *
Your answer
Type of School / Educational Institute / Community Site *
Grade Level of Participants *
Select all participating grade levels
Required
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