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 60 minutes in length and we need 15 minutes between each session.
  • Maximum number of students per class is 20 for K-2 grades and 32 for 3-6 grades.  
  • Workshops are generally conducted during the school day. If you are interested in after school enrichment, please email mail@madsciencesd.com or call (858) 300-2481.
  • A travel fee will apply.
Start Time

Teacher/Grade

 # Of Students Room #

1.

2.

3.

4.
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GATE Students:          


 Additional scheduling details:
  

a

 PAYMENT INFORMATION

Send Invoice To:

Promo Code:

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 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.