Preschool Workshop Request Form


	Preschool Workshop Request Form

Please use this form to indicate your preferred workshop date(s) and topics(s). Once we have received your request, we will send you a confirmation letter via email. If you are interested in scheduling a series of workshops and this request form will not accommodate your needs, please email mail@madsciencesd.com or call (858) 300-2481.
CUSTOMER INFORMATION
School or Organization:
Address:
Contact Name:
Position:
CONTACT INFORMATION
It is important that we are able to contact you if we have any questions. Please provide a phone number and the best time to contact you. Your email address will be used to send you a confirmation letter and teacher resource materials.
Day Phone:
Cell Phone:
Best Time To Call:
Email:
Best Method Of Contact:
WORKSHOP DATE(S)
1st Choice:
2nd Choice:
3rd Choice:
Additional Information:
WORKSHOP TOPIC(S)

WORKSHOP SCHEDULE
Before you schedule your workshop(s), there are a few things you should be aware of: Workshops are 45 minutes in length and we need 15 minutes between each session. Maximum number of students per class is 20 with an assistant provided by your location. A travel fee will apply.
	Start Time	# Of Students	Room #
1.
2.
3.
4.
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Additional scheduling details:
a
PAYMENT INFORMATION
Send Invoice To: Name, Position, School/Organization and Address.
If your school/organization requires a contract (i.e. independent contractor agreement, consultant services contract, lecturer/presenter contract, etc.) please send the required paperwork to Mad Science as soon as possible at the following address: Mad Science 5555 Magnatron Blvd. Ste. F, San Diego, CA 92111. For your records, our Federal Tax I.D. # is 33-0724298. If a contract is required to generate payment, Mad Science reserves the right not to conduct the program on the scheduled date(s) and time if the proper contract is not in place.

This form is to request a preschool workshop. Clicking on the submit button will transfer your workshop request to Mad Science of San Diego Please do not submit this form for an inquiry only. Send your inquiries to mail@madsciencesd.com.