Mad Science of the Mid-Hudson
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Event Request Form
Customer Information
School or organization name:
Contact name:
Position:
Phone number:
Email address:
Event Details
1st Choice:
Occasion(Science Night, Assembly, etc.) Please supply 2nd/3rd choice date. :
Tell us what you are interested in:
Shows (performance for 30-175 children)
Demonstration Activity Stations
Make-and-Take Fun Stations (includes take home project)
Event will be during the school day
Event will be held in the evening
Event will be on the weekend
We have volunteers to staff some stations to reduce cost
Additional Requests & Comments
Use the box below to give us any other pertinent information.
Comments:
Please send me special offers and cool experiments
Submit