Minisink Valley Historical Society
Education Outreach Program Request Form

Name of Group:_____________________________________________________

Address:___________________________________________________________

City, State Zip Code: _________________________________________________

Contact person: _____________________________________________________

Phone Number:______________________________________________________

Location where the program will be held if different from the listed address:

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

Please designate the program you would like:

• Stephen Crane: His Life & Times
• The Delaware and Hudson Canal: From Canalway to Greenway
• The Forestburgh (N.Y.) Log Cabin Restoration Project
• John Newton Howitt: A Noble Spirit Among Us
• Graveyard Art
• Silent Cities: The History of Graveyards and Cemeteries in America
• Franklin D. Roosevelt: A Rendezvous with Destiny
• Eleanor Roosevelt: First Lady of Courage
• We Can Take It: The Roosevelt Tree Army at High Point State Park 1933-1941
• While New Jersey Slept, New York Was Wide Awake
• When Bluestone Was King

Date of Program:_____________________________________________________

Time of Program:_____________________________________________________

Fee for program: $175.00 (Payable on the night of the program)

Check to be made to the "Minisink Valley Historical Society"

Please return a copy of this form to:
the Minisink Valley Historical Society
125-133 West Main Street, Post Office Box 659
Port Jervis, New York 12771

Phone: (845) 856-2375 / Fax: (845) 856-1049

World Wide Web Site: http://www.minisink.org