Outreach Program Visit Request
Please be aware submitting this form DOES NOT confirm your reservation and only serves as a request for booking with the Kentucky Derby Museum team.
School/ Organization Name
*
Primary Booking Contact Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Title/Role (teacher, activity director, FRC coordinator, etc)
*
Address of the Outreach Visit
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Who will be participating in the outreach visit?
*
All Grade Levels in the School/Organization
Select Grade Levels in the School/Organization
Other (please describe in the comments box)
Which Grade Levels?
Pre-K
K
1
2
3
4
5
6
7
8
9
10
11
12
Questions/Comments
Submit
Should be Empty: