– Virtual Group Program Registration

Virtual Group Program Inquiry Form

GROUP / ORGANIZATION / SCHOOL INFORMATION
Group / Organization / School Name
Address
Street Address City State / Province / Region ZIP / Postal Code
Contact Name
Phone
Email Address
Best time to reach you?*
PROGRAM INFORMATION
I am interested in the following programs:
- Activity Bags
- Imagine "Explore It" Clubs
- Little Explorers Science
- Memory Makers
- Virtual Classroom Program (Museum On-the-Go)
- Trivia Time
Total number of participants anticipated
Number of class/group sessions
SCHEDULE
Preferred Date(s)
Preferred Time(s)
PAYMENT INFORMATION
Payment will be made by
- Credit Card
- Purchase Order
How did you hear about us?
Comments (special needs, etc.)
Captcha

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