You may submit this form online. Mail a printed copy of application and 30% deposit to the address below.
EDUCATION PROGRAM REGISTRATION FORM
Center for American Archeology, Kampsville, IL

I would like to attend the Program listed below.
Participant's Name: Age:MaleFemale

Social Security Number: Source of Contact: 

Address:

 City: State: Zip Code: 

Home Phone: Work Phone: 

Paren/Guardian's Name: 

I will/may require transportation.

Adult participants/Teachers please complete the following:
 

Occupation: Grade Taught: 

Business/School Address: 

City: State: Zip Code: 

Program you wish to attend:
Program Name: 

Cost: 

Dates you wish to attend:
1st Choice Date: 2nd Choice Date: 

Send Deposit to:
Education Admissions Office
Center for American Archeology
Box 366
Kampsville, IL 62053

 phone: 618-653-4316