Programs Request Form
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Name *
First & Last
Email *
Phone *
School/Organization Name *
School/Organization Address *
Grade(s) and Age(s) of Your Group *
Number of Participants (Including Students & Adults) *
Preferred Program Date *
or best guess!
MM
/
DD
/
YYYY
Alternate Program Date *
or best guess!
MM
/
DD
/
YYYY
Preferred Program Start Time *
or best guess!
Time
:
What Type of Program(s) Are You Most Interested In? *
Program Subject Requested *
School Memberships are available to individual schools that are interested in securing program discounts, special materials such as weather stations for your school and accompanying curriculum. Are you interested in becoming a MWOBS School Member?  *
If you answered "Yes!" to the question above, please let us know what level of membership you are most interested in:
Clear selection
Does Anyone in your Group Need Special Accommodations? (If Yes, Describe Needs) *
If Requesting Financial Aid, Please Provide a Supporting Explanation and How your Group Would Benefit
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This form was created inside of Mount Washington Observatory.