Teacher / Contact Name:	* Required
E-mail Address:
School Name	* Required
Phone Number	* Required
Fax Number
School Postal Address:
	State: Postcode:
Have you been on a Lessons Afloat Excursion before ?	Select Yes No
If No, how did you hear about us ?
EXCURSION DETAILS
Preferred Month	Select January February March April May June July August September October November December
Preferred Date	Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Half Day	Select 10am - 12pm 12pm - 2pm
Full Day	Select 10am - 2pm
Optional Shark Island visit	Select Yes No
Number of Students
Year (K - YR 12)
Unit Focus
Additional Comments / Enquires