School Program Registration Form - Mount Rushmore National Memorial

School/Group Name:

Contact Name:

Mailing Address:

City:
State: Zip:

E-mail Address:

Telephone Number: -

Fax Number: -

Please include me in future Education Mailings: YES NO

Date Requested: 1st Choice 2nd Choice

Time Requested:

Program Requested:

Number of Students:

Grade Level:

This form is for classroom reservations only. To make a reservation contact the Education Specialist, Rhonda Schier, (605) 574-3134, or fill out the online reservation form, print and mail to Mount Rushmore National Memorial, 13000 Hwy 244, Bldg 31 Suite 1, Keystone, SD 57751.