Royal Tyrrell Museum Distance Learning Course Registration

Thank you for your interest in our Distance Learning Programs. Please complete the following form as thoroughly as possible.

Please Note: If you are booking multiple programs, please submit one form for each program! After submitting, you will have the option to re-use the information you previously entered.

All fields marked with "*" are required.

Contact Information

* Contact First Name:
* Contact Last Name:
*Contact Email:
*Contact Phone:: () -
*Contact Fax:: () -
*Contact School/Organization:
* On Weekdays, when is it best to talk to you?
* How did you hear about our Distance Learning programs?

Event Related Information

*School/Organization:
* Teacher First Name:
* Teacher Last Name:
* Teacher Email:
*School/Organization Contact Phone:: () -
*School/Organization Contact Fax:: () -
* Address 1:
Address 2:
* City:
* Province/State:
* Country:
* Postal/Zip Code:
* Time Zone:

* Which program are you interested in?
*Grade/Age Level
* Number of Participants
To accommodate class scheduling our programs are booked in a time slot fashion. Your program may start at any time within the selected time slot. Once you have selected your time block please ensure you select a start time. All program times are in Mountain Time. Please Note: A minimum of 7 days advance notice is required for all bookings.
* First Preferred
: Time:
* Second Preferred
: Time:
Third Preferred
: Time:
What type of setting will the event be held in?
Has your group participated in a video conference before?
Any further comments and or questions about the event?

Technical Contact Information

* Contact Name:
* Phone Number:: () -
Cell Number:: () -
* Email:

Certificate or Coupon #

Please Note: All Royal Tyrrell Museum Distance Learning coupons and certificates have 4 or 5 digits, numerals only. If this does not match what you have on hand, please contact the individual or organization that issued the coupon or certificate.
Certificate or Coupon #:

Royal Tyrrell Museum Distance Learning Course Registration

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