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* 1. Contact Information

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* 2. How many students do you estimate to be in attendance at the program?  This will impact pricing.  These are number per program: if you are requesting 3 programs simply provide the amount expected to attend each.

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* 3. Where would you like your program?

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* 4. What grade level is your group?

If the contact information for the group coordinator is different from above please provide below.

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* 5. What is the name of the group coordinator ?

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* 6. What is a good email address to reach the coordinator?

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* 7. What is a good phone number to reach the coordinator?

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