AGO TEACHER PROGRAMS – Customized Booking Request Form 2013-2014 We look forward to providing you with professional learning that is customized to your needs at the AGO! This form is a REQUEST ONLY – an AGO staff member will contact you to confirm your registration once we have processed your form. Please submit this request form AT LEAST THREE (3) WEEKS PRIOR to your requested event date. For more information, please contact AGO School and Teacher Programs at Teacher_Programs@ago.net. Name*Daytime Telephone Number*Ext.Alternate Telephone NumberExt.Email Address* School/Board/Institution Name*School/Board/Institution Address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Customized Booking DetailsNumber of Instructors / Group LeadersNumber of Participating TeachersDemographics of your group – please choose one Practicing classroom teacher (in-service) Teacher-in-training (pre-service) Other (please explain) Demographics of your group (Other)Preferred LanguageWhat language would you like your program to be delivered in? Please choose one.EnglishFrenchPlease provide a description of the participating teachers(e.g., Grade level(s), Additional Qualification, Professional Learning Community, Subject Association)Date of Visit (1st choice)Please enter a date formatted as MM/DD/YYYY. Date of Visit (2nd choice)Please enter a date formatted as MM/DD/YYYY. Start time of Visit : HH MM AM PM End time of Visit : HH MM AM PM Type of Program Guided Tour only (half-day: 90 minutes to 2 hours) Artmaking Workshop only (half-day: 90 minutes to 2 hours) Guided Tour and Artmaking Workshop (full-day: up to 4 hours) Other (please explain) Type of Program (Other)Choice of Collection / Exhibition AGO Collection only (AGO collection and special exhibitions included in general admission) Special Ticketed Exhibition only (major special exhibitions requiring a separate admission ticket) AGO Collection and Special Ticketed Exhibition How would you like us to customize your visit?Please describe what kind of experience you would like your teachers to take away.Would you like to order food and/or drinks? (Additional costs will be charged)YesNoPlease explainDo you require the use of a meeting room?(Subject to room availability)YesNoPlease explainPayment Method*FINAL CONFIRMATION is contingent upon receipt of payment – please choose one form of payment:Credit card (Credit card information will be confirmed by phone)Cheque (A credit card number is required to hold the booking. Group Sales staff will contact you.)Invoice (Please provide name of addressee if different from your own)Name First Last AGO Teachers’ Access Program (TAP)Register for the AGO’s Teachers' Access Program and receive FREE general admission to the Gallery, invitations to exclusive teachers' events, the Educators' eNewsletter, resources and tools for use in the classroom – and much more! Registration for AGO TAP is FREE with a valid Ontario College of Teachers (OCT) card. Yes, I would like to register for TAP – here’s my OCT ID number OCT ID number This iframe contains the logic required to handle AJAX powered Gravity Forms.