Mahaffie Visits Your School Registration

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Please correct the field(s) marked in red below:

1
Date Requested
 *
2
Time Preferred
 *
Time Preferred
3
School Name
 *
4
School Information
 *
School Information
5
Teacher Information
 *
Teacher Information
6
Grade Level
 *
7
Program
 *
Program
8
How many will be participating?
 *
How many will be participating?
9
How many souvenir bags do you want to purchase for $1 per bag?
 *
10
Do you have any special needs students?
 *
Do you have any special needs students?