Science Night Request Form


	Science Night Request Form

Use this form to indicate your Science Night 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
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 where you can be reached. Your email address will be used to send you a confirmation letter.
Day Phone:
Cell Phone:
Email:
SCIENCE NIGHT DATE(S)
1st Choice:
2nd Choice:
3rd Choice:
Additional Information:

SCIENCE NIGHT DETAILS
Start Time:
Package:
Grade Level:
Room Location:
j
Our School has had a science night with Mad Science before.
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 Science Night. Clicking on the submit button will transfer your Science Night request to Mad Science of San Diego Please do not submit this form for an inquiry only. Send your inquiries to mail@madsciencesd.com.