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SciTech Outreach and Science2Go Registration Form
Thank you for your interest in bringing SciTech to you!


For more information on program details, please contact the SciTech Education Department at explore@scitechmuseum.org or 630-859-3434 x231.

Organization Name *
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Organization Street Address *
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Organization City *
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Organization State *
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Organization Zip Code *
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Contact Name *
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Contact Email *
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Contact Phone Number *
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Alternate Phone Number *
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Date Requested *
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YYYY
Alternate Date Requested *
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Start Time *
When would students begin programming?
Time
:
How many hours? *
Hrs
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Min
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Sec
Type of Outreach or Science2Go Requested *
(See our website or call for details about each of the following.)
Topic Area *
(See our website or call for details.)
Your answer
SCIENCE2GO DEMOS AND LABS ONLY: Number of Students *
(For Demos, maximum 75 students per Demo; For Labs, maximum 25 students per lab grouping and maximum 75 students per hour session; If you are not requesting a Demo or Lab, please type NA.)
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Grade/Age Level *
(See our website or call for details.)
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Number of teachers/adult chaperones available during event *
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Number of rooms available for programming *
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Maximum total capacity of rooms available for programming *
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Large room availability *
(Please list any large rooms that will be available for programming.)
Required
Does your group have any other special needs, such as language, food allergies, bee allergies, etc? *
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Comments *
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