Request a Program

Education Program Request Form


Group Name:*
Type of Organization:*
Primary Contact Name:*
Contact Address:
Phone Number:*
-
E-mail:*
Preferred Contact Method:*
Location for Presentation:*
Presentation Address:

*If you wish to hold the program at WINC, please leave the Location Address blank.

Estimated Attendance:
Preferred Date:*
Preferred Time:*
 : 
Age/s of Group:
Alternate Date:
Alternate Time:
 : 
Estimated Length of Program:*
Please select all features you wish to include in your program:*
If the program is at your location, which of the following items are you able to provide?*

*Please note: For small groups, the Wildlife In Need Center currently has facilities for on-site education.

WINC Program History:

You understand that the Wildlife In Need Center requests a $200 donation for an education program and agree to pay the full amount.  This donation can be met monetarily, through in-kind donations, or a combination of both.  If the $200 donation is not feasible, please select the second option to discuss your options further with our Educational department.

Agreement:*