| Name: |
|
| Address: |
|
| City: |
|
| State: |
Wisconsin |
| Zip: |
|
| Day
Phone: |
|
| Evening
Phone: |
|
| E-Mail: |
|
Dates
you will be in Washington:
(not counting travel dates) |
|
Mobility
Concerns:
(Wheelchair, Stroller, Vision/Hearing Impaired,
etc.) |
|
| If
your group is 10 or more: |
| Name
of School/Group: |
|
| Grade
Level or Age Range: |
|
| |
#
of Children:
|
| |
#
Adults |
What
would you like to see?
(Please check all that apply) |
| The
Capital: |
|
| The
White House |
|
| Bureau
of Printing & Engraving |
|
| Supreme
Court |
|
| Library
of Congress |
|
| Other
Info: |
|
|
|
