Mad Science Special Event Booking Form
Please fill out the entire form to the best of your ability. Once we receive your form, you will receive a confirmation back from us.

Please note that by filling out this form, you are BOOKING an event. There is a $35.00 cancellation fee if you cancel your event within two weeks of event date, and a $75 cancellation fee for cancelling within 48 hours of event date.

If you do NOT receive an email from us within 2 business days, please email us at MadScienceRocks@gmail.com. Thanks!
Email address *
'Day of Event' Contact Name: *
Your answer
School/Organization Name: *
Your answer
Billing Address: *
Your answer
Event Location (if different than Billing):
Your answer
Event Location ZIPCODE *
Your answer
Location Directions (Best Place to Park/Unload/etc) *
Your answer
Will the Event be Indoors or Outdoors? (Outdoors can be done October-April ONLY $25 addl' fee for outdoors. Restrictions Apply. Please contact us before booking an outdoor event.) *
Best “Day-of” Phone Number: *
Your answer
Customer Email: *
Your answer
Date Requested ($25 Last Minute Booking Fee will apply for bookings made within 1 week of event date) *
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START Time(s) Requested: (Please put the time you'd like us to START the show/event) *
Time
:
END Time Requested: (Please put the time you'd like us to END the show/event) *
Time
:
Second Choice Date: *
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Second Choice Time: *
Time
:
Grade of Attendees (Choose all that apply): *
Required
Approximate Number of Attendees *
Service Requested: *
Length of Event (if doing Stations or Science Night)
SPECIAL EVENT ASSEMBLY SHOW Requested:
DISCOVERY STATION(s) Requested:
MAKE AND TAKE STATION(s) Requested:
SCIENCE NIGHT PACKAGE Requested:
If doing a Show AND Stations (Electron Package), which option would you like?
SCIENCE NIGHT PACKAGE Show Option:
SCIENCE NIGHT PACKAGE Discovery Station Options (Choose 2 for Electron or Atoms Package)
SCIENCE NIGHT PACKAGE Make and Take Station Option (Pick ONE for Electron or Atoms Package)
Would you like to add any MAN YOUR OWN Stations? (Can ONLY be added to a Science Night Package)
Will you be doing some sort of "Passport" that the students will need stamped or signed?
Will all activities be in the same room/location? *
Do you have a microphone that our Scientist can use (Lapel Preferred)?: *
How will you be paying for the event? *
Any Restrictions? (No Water/Electric nearby, No Fire Allowed)
Your answer
How did you hear about us?
Promo/Coupon Code
Your answer
Anything else we need to know?
Your answer
I understand that by filling out this form, that I am committing to the dates in this form. If I need to cancel for any reason, I understand that I must do so at least 2 Weeks before the event date, or I will get charged a cancellation fee. Please initial below to confirm your booking. *
Your answer
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