Science on Wheels Public Program Registration Form
Please scroll down and fill out the form below to request a Science on Wheels public assembly, workshop or Portable Planetarium program visit from Roper Mountain Science Center. Our public programs are intended for public venues such as libraries, camps, Math and Science nights, and community events.

If you would like to request one of our school programs instead, please go to the website below and click the appropriate registration link there:

If you do not yet have enough details to complete the request form, but would like to hold a date or get more information, please contact the Outreach Specialist, Jennifer Romatelli at

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Email *
Organization Name *
Street Address for program location *
Please include the street address of your organization, This will be used to get driving directions to the program location, so please do not use PO boxes.
City State and Zip Code for the program location *
Please include all 3 so we can enter your address in our database
Organization phone number *
Name and title of requestor *
Your name and title at the venue
Requestor phone number *
best number to contact you
How would you prefer we contact you? *
Name and title of person responsible for payment *
name of whoever will process your payment - if you believe you qualify for grant funding, just type NA in this field
Phone number of person responsible for payment *
Phone number for the person in the previous question - again type NA if you believe you qualify for grant funding
First Choice Date *
Select your first choice date for the visit.
Second Choice Date
Select your second choice date for the visit.
Third Choice Date
Select your third choice date for the visit.
Location of Program(s)
In which room or space at your site will the program(s) take place? Please refer back to the public programs website for space requirements. Programs cannot be moved from one space to another once set up.
Please tell us what kind of audience you are expecting for the program(s) (family groups, children, age groups, etc.) Our programs are best suited for ages 5 and up but can be adapted for a pre-school audience if requested.
Program *
What program would you like to reserve?
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