Science on Wheels Builder Workshop Registration Form
Please scroll down and fill out the form below to request the Science on Wheels Builder Workshop program to visit from Roper Mountain Science Center. This program is available both for school groups and for public venues such as libraries, camps, day cares and community groups.

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 jromatelli@greenville.k12.sc.us or 864-355-8940.
Organization Name *
Street Address of the organization *
Please include the street address where the program will take place. This will be used to get directions to your site, so please do not use PO boxes.
City, State and Zip Code of organization *
Organization phone number *
Name and title of requestor *
Your name and title at the venue
Requestor phone number *
best number to contact you
Requestor email address *
your email address
How would you prefer we contact you? *
Required
Name and title of person responsible for payment *
Your bookeeper's name, or the name of whoever will process your payment (if you are requesting grant funding, just put N/A)
Phone number of person responsible for payment *
Phone number for the person in the previous question (if you are requesting grant funding, just put N/A)
Name and title of person responsible for payment *
Your bookeeper's name, or the name of whoever will process your payment (if you are requesting grant funding, just put N/A)
Phone number of person responsible for payment *
Phone number for the person in the previous question (if you are requesting grant funding, just put N/A)
First Choice Date *
Select your first choice date for the visit.
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Second Choice Date
Select your second choice date for the visit.
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Third Choice Date
Select your third choice date for the visit.
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YYYY
Location of Program(s)
In which room or space at your site will the program(s) take place? Please refer back to the builder workshop website for space requirements. Programs cannot be moved from one space to another once set up.
Audience
Please tell us what kind of audience you are expecting for the program(s). For public groups the minimum age is 7. For school groups the program is recommended for grades 2 through 8.
How many program sessions do you require? *
Capacity is 20 participants for public groups, or one class for school groups
Session 1 Start Time
See the planning information on the Science on wheels page for our scheduling restrictions.
Time
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Session 1 End Time
We recommend scheduling 60 minutes, but can do shorter if timing requires.
Time
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Audience Size
Please estimate the number of participants attending session 1. Capacity is 24 participants (not including adult helpers) for public groups and one class for school groups.
Session 2 Start Time
If needed - please allow at least 15 minutes between the end of session 1 and the beginning of session 2.
Time
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Session 2 End Time
Time
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Audience Size
Please estimate the number of participants attending session 2.
Session 3 Start Time
If needed - please allow at least 15 minutes between the end of session 2 and the beginning of session 3.
Time
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Session 3 End Time
Time
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Audience Size
Please estimate the number of participants attending session 3.
Session 4 Start Time
If needed - Please allow a minimum of 15 minutes between all sessions. For a 4 session reservation, there must be a 30 minute or longer meal break between any two sessions at some point during the visit.
Time
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Session 4 End Time
Time
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Audience Size
Please estimate the number of participants attending session 4.
Anything else we should know?
Please let us know if there are any other details you think might be helpful to us.
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