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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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DD
/
YYYY
Alternate Date Requested
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YYYY
Start Time
When would students begin programming?
Time
:
How many hours?
Hrs
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Min
:
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.)
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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.)
Your answer
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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