STAR Power Pack Request Form

 

Please use this form to indicate your program preferences. Once we have received your request, we will contact you to schedule program dates, times and topics.

You can also contact Mad Science at mail@madsciencesd.com or call (858) 300-2481.

 

CUSTOMER INFORMATION

School:
Address:
Contact Name:
Position:
Day Phone:
Cell Phone:
Email:

LITTLE DIPPER PACKAGE (4th Grade Series):
Workshops per Class:  3      6        9
# of 4th Grade Classes:
4th Grade Lead Teacher:
Lead Teacher Email:

 

BIG DIPPER PACKAGE (5th Grade Series):

Workshops per Class:

 3        6        9

# of 5th Grade Classes:

5th Grade Lead Teacher:
Lead Teacher Email:


ADDITIONAL SCHEDULING DETAILS:
  

     

 

Clicking on the submit button will transfer your STAR Power Pack request to Mad Science of San Diego