Historical Museum of Southern Florida Graphic
 
Discovery Days Registration Form 2008-09

Pleace complete the form below and click the Submit button. If you are registering more than one child you will need to register each child separately.

If you have any questions please call 305-375-1492 or e-mail education@hmsf.org.
Student's Information
First Name
Last Name
Gender Male Female
Date of Birth
Age
Home Phone Ex. 305-555-1234
Home Address 1
Home Address 2
City State Zip
Parent/Guardian’s Information
First Name
Last Name
Work Phone Ex. 305-555-1234
Cell Phone Ex. 305-555-1234
Home Phone Ex. 305-555-1234
Email
Same as Student Information above (This is for billing purposes.)
Address 1
Address 2
City State Zip
Country
Medical Information
List Any Medications
List Any Allergies
Special Needs
Emergency Contact
Phone
Physician’s Name
Phone
Please List Any Other Person(s) Authorized to Pick up Your Child (Separate names by commas)
Dates Information
  HMSF members Non-members   HMSF members Non-members   HMSF members Non-members
Tuesday, September 30Miami Hurricane's History $35 $40 Thursday, October 9
Urban Environmentalists		 $35 $40 Friday, October 24
Latin American Vistas		 $35 $40
                 
Tuesday, November 4South Florida of the Future $35 $40 Friday, January 16, 2009
Paleo-Historians		 $35 $40 March 30, 2007 Caribbean Castaways $35 $40
                 
March 30, 2007 Caribbean Castaways $35 $40            
 
Sign up for all 7 Discovery Days and save! $220 $252
Fee includes snack. Children must bring their own lunch.
I will not be registering a child but wish to make a contribution to the Historical Museum in the amount of $

If you prefer to mail this form to us please complete the registration form (please print) and send with full payment to:
Education Department,
Historical Museum of Southern Florida
101 West Flagler St.
Miami, FL 33130.

Confirmation letters will be mailed upon receipt of your registration form and full payment.

For additional registrations, please photocopy this form. For more information, call 305-375-1492.