Program Information Request Form

* 1. Address

Name

School/Company

Address

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

* 2. Group Type

* 3. What program(s) are you interested in?

Challenger Learning Center (5th grade and above)

Planetarium

Challenger and Planetarium (5th grade and above)

* 4. Number of Students/Participants

* 5. What month(s) are you interested in?

January

February

March

April

May

June

July

August

September

October

November

December

Please Note: The programs for Out-of-School Time and Community groups are offered on Tuesdays or Thursdays after 2:00pm. We also offer programs on the First or Second Saturday of each month.

* 6. What grade are your students?

Pre-K

Other (please specify)