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									                                Looking Back: The Civil War in Tennessee
                                Reservation Request
                                Location: The Discovery Museum
                                          305 East College Street, Jackson, TN 38301
                                Date: Thursday, November 1, 2012
                                Time: 3:00 pm -- 7:00 pm

Participation in Looking Back: The Civil War in Tennessee is open to all individuals who are interested in
preserving Tennessee's Civil War history through the digitization of historic materials.

To submit a reservation request, complete this form and send via email to civilwar.tsla@tn.gov.
Reservations are also accepted by calling 615-741-1883 and providing the information below or by faxing
the form to 615 532 5315. A staff member will contact you to confirm your reservation time.

*Name:

Address:

*Telephone:

*E-mail:

*required information

Please select your three (3) preferred time slots and indicate whether or not you wish to be
placed on a wait-list.

3:00 – 3:45                                                 6:00 – 6:45
3:30 – 4:15                                                 6:30 – 7:00
4:00 – 4:45
4:30 – 5:15
5:00 – 5:45
5:30 – 6:15
please add my name to a waiting list (if needed)

								
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