JAPANESE CULTURAL EXPERIENCE RESERVATION
APPLICATION FORM
NAME OF SCHOOL: __________________________________________________________________
SCHOOL ADDRESS: _________________________________________________________________
(incl. City)
_________________________________postal code______________________
TEACHER’S NAME ___________________________________________________________________
PHONE # _______________________________FAX # _______________________________________
Inner-city school?
Yes / No
EMAIL ADDRESS: ____________________________________________________________________
DATE YOU HAVE CHOSEN
(circle one of the following)
AM or PM?
Total # of students
*VJLS only*
Thursday October 30th, 2014
Thursday November 20th, 2014
Thursday December 4th, 2014
Thursday January 15th, 2015
Thursday February 5th, 2015
Thursday February 19th, 2015
Thursday March 5th, 2015
Thursday March 26th, 2015
Thursday April 16th, 2015
Thursday April 30th, 2015
Thursday May 14th, 2015
Thursday May 28th, 2015
Would you like to visit a Buddhist Temple? Yes No (circle one)
If you choose “Yes”, please circle one temple you would like to visit.
* Tozenji Temple in Coquitlam *
*Steveston Buddhist Temple in Richmond*
Please complete and fax to 604-254-9556 or Email to <jcep.keiko@gmail.com> to
the attention of coordinator, Keiko Yagi. FIRST-COME-FIRST-SERVED BASIS.
CANCELLATIONS:
Please note: when your field trip is cancelled within one week of the scheduled date,
there will be a charge in the full amount.