Location

*Is this an outdoor venue? YES NO

*Name of School/Other Location:


*Address:


*City:


*State:


*Zip Code:


*County/Township:


*Phone at this Location (Area code+ext.):


Alternate Phone/Fax:


Email address:


Name of Principal/Person in charge:


Offer code (if applicable):


Contact Person
If you would like to have the confirmation packet sent to your address rather than to the school, please check the following box:
Yes, send the information to me.

How did you hear about Traveling Science Shows?:
Select Traveling Science Brochure Field Trip Planner Browsing this website/the web Word of mouth Other

*Name of Person Making Reservation:


*Home Phone:


Alternate Phone/Fax:


*Best time to reach person:
Select early morning late morning early afternoon late afternoon

*Personal email address:


*Address:


*City:


*State:


*Zip Code:


Choose Your Science Shows
Please indicate preference for three of the following show topics.

*Topics:
First Topic Choice:
Select show Weather Chemistry Electricity Life in Space Flight Light & Color Motion & Machines Hot & Cold Human Body

Second Topic Choice:
Select show Weather Chemistry Electricity Life in Space Flight Light & Color Motion & Machines Hot & Cold Human Body

Third Topic Choice:
Select show Weather Chemistry Electricity Life in Space Flight Light & Color Motion & Machines Hot & Cold Human Body

*Please list three different date choices for shows.
1st Date Choice:


2nd Date Choice:


3rd Date Choice:


*Total number of students:


Number of performances (max=4):
Select One Two Three Four

Times and Grades (Allow 15 minutes between shows and 30 minutes between topics). To choose multiple grades for a performance, hold down the Shift key when selecting

First Performance Time: Select grade from list... Kindergarten First Second Third Fourth Fifth Sixth Seventh Eighth	Second Performance Time: Select grade from list... Kindergarten First Second Third Fourth Fifth Sixth Seventh Eighth
Third Performance Time: Select grade from list... Kindergarten First Second Third Fourth Fifth Sixth Seventh Eighth	Fourth Performance Time: Select grade from list... Kindergarten First Second Third Fourth Fifth Sixth Seventh Eighth

Traveling Exhibits

Topics:
Select one... No Traveling Exhibit Electricity Structures

Dates:
First Choice:
Beginning:   Ending:

Second Choice:
Beginning:   Ending: