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PASSPORT Request Form INSTRUCTIONS: 1. Complete PASSPORT Request Form and e-mail it to [email protected]. 2. Pink Palace Staff will confirm your reservation by e-mail and attach an invoice. School Name: ___________________________________________ Teacher Name: __________________________________________ Teacher E-Mail: _________________ Grade Level: _________ Number of Students: _______ Teacher School Phone Number: _____________ Ext. __________ Teacher Cell (or other Phone): _____________________________ By submitting this request, I agree to provide more than one week’s notice of cancellation of my reservation. Canceling a reservation less than one week prior to the reservation date may result in a $5 penalty. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 PASSPORT Topic(s) Requested: Enter topic(s) from this list of topics into the Request Form below. Giant Animal Cell Model Giant Plant Cell Model Animal and Plant Cell Models (classroom set of 4 animal and 4 plant cell models) Animal Cell Mitosis Models (set of 9 models) Compound Light Microscope with a set of prepared slides. Select from Animal & Plant Cell Structure (5 slides) OR Animal & Plant Cell Mitosis (2 slides) OR Household Curiosities (8 slides). Ten Microslide Viewers with a set of 10 Slide Strips. Select from Cell Structure OR Plant Mitosis OR Cells of Your Body. Extreme Cold Weather Gear Leaves Learning Labels (Nutrition) Weddell Seals Insects Sharks Fit Kids Weather Instruments Tree Cookies Reservation Period Aug 8-19, 2016 Aug 15-26, 2016 Aug 29-Sept 9, 2016 Sept 5-16, 2016 Sept 19-30, 2016 Sept 26-Oct 7, 2016 Oct 17-28, 2016 Oct 24-Nov 4, 2016 Nov 7-18, 2016 Nov 14-22, 2016 Nov 28-Dec 9, 2016 Dec 5-16, 2016, 2016 Jan 2-13, 2017 Jan 9-20, 2017 Jan 23-Feb 3, 2017 Jan 30-Feb 10, 2017 Feb 13-24, 2017 Feb 20-March 10, 2017 March 20-31, 2017 March 27-April 7, 2017 April 10-21, 2017 April 17-28, 2017 May 1-12, 2017 May 8-19, 2017 PASSPORT Topic Fee