Serpentarium Outreach Program Request Form
Please contact us via email at eserpentarium@bellsouth.net with questions.
Email address *
Company or Group Name *
Your answer
Venue Address: (Must Include City/State/Zip to be valid) *
Your answer
Contact Name: *
Your answer
Contact Telephone *
Your answer
Email Address: *
Your answer
Visit Date - 1st Choice *
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YYYY
Visit Date - 2nd Choice (Must be different from 1st Choice) *
MM
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DD
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YYYY
Visit Arrival Time ( Please allow 30 minutes to 1 hour for setup) *
Time
:
Program Desired: (See descriptions on outreach page) $300 each. *
Additional Programs Requested ($75.00 each) Up to 3 additional programs per visit. Up to 2 programs may be added to Scaly Friends.
Your answer
Additional Hours for Scaly Friends ($75.00 each) up to 2 additional hours per visit. No Shows.
Your answer
Additional Information or Requests: Please note any requests, special needs or information here (e.g. No Venomous, bring PA system, tent provided, etc.).
Your answer
Travel Fees Apply *
Other
If you desire to book multiple days or a series of shows, please email us directly at edistoserpentarium@bellsouth.net.
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