Science Day Request Form


	Science Day Request Form

Use this form to indicate your Science Exploration Day preferences. Once we have received your request, we will send you a confirmation letter via email. Please do not submit this form for an inquiry only. Send your inquiries to mail@madsciencesd.com.
CUSTOMER INFORMATION
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 where you can be reached. Your email address will be used to send you a confirmation letter.
Day Phone:
Cell Phone:
Email:
SCIENCE EXPLORATION DAY DATE(S) If your school needs more than three sessions, Mad Science will conduct the program in two days.
1st Choice Date(s):
2nd Choice Date(s):
3rd Choice Date(s):
Additional Information:

SCIENCE EXPLORATION DAY DETAILS
# of Sessions:
Start Time:
Grades:
Room Location:
Additional Scheduling Details:
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 Science Exploration Day. Clicking on the submit button will transfer your request to Mad Science of San Diego Please do not submit this form for an inquiry only. Send your inquiries to mail@madsciencesd.com.