Registration Form

Use this form to organize your information before calling to make your reservations. If you prefer, you may mail the completed form to:

Program Registrar
Genesee Country Village & Museum
1410 Flint Hill Road
P.O. Box 310
Mumford, N.Y. 14511-0310

... or fax it to (585) 538-6927. Be sure to include your phone number and the best time to reach you. We will confirm all arrangements in writing in advance of your visit.

Contact Person:  
Institution Name:  
Address:  
City / Town:   State:   Zip Code:  
Phone:  (         ) Fax :  (         )
E-Mail:  
Best Time To Call:  

School District:  
County:   State:  
Bus Company or
transportation method: 		 

First Program Name:  
Date/Time:   # of Students:  
Second Program Name:  
Date/Time:   # of Students:  
Third Program Name:  
Date/Time:   # of Students:  
Alternate Program Name
(if my choice is not available):		  
Date/Time:   # of Students:  

** Please indicate if any student in your group has special needs on a separate sheet of paper. **