
	Request a Mad Science Party!

To plan a Mad Science party please contact us at 603-362-9800, by e-mail at info@madsciencenhma.com or please fill out the form below.

NOTE: Party dates and times are subject to availability. A Mad Science Specialist will contact you to confirm your party plans.

Click "Submit" when form is complete.

Mad Science Party Request Form


What Prompted your Visit Today?
Your Name:
Email Address (required):
Home Phone Number:
Work Phone Number:
Cell/Alt. PH Number:
Best Time to Call:
Please Call Me At:	Home Work Cell/Alt.
Street Address:
City/State:
Zip Code:

Birthday Child's Name:
Child's Actual Birthdate:
Child's Gender:	Male Female
Child's School:

Requested Party Date:
Requested Party Time:

I may be interested in:
Additional Supplies: Invitations Goody Bags
Additional Activities:	For more information
Bubbling Portions(Dry Ice)	Cotton Candy
Laser Lights	Rocket Launch
Van DeGraff
Party Location: (if different from home address given above)
Location: (ie XYZ Country Club)
Street Address:
City/State:
Zip:
Comments/Special Instructions:

Mad Science Party Request Form