Science Ambassadors

UTA Campus Visit

Cost: $125 for first 50 plus $1.50 per additional person

**Please note: This request form is not a show confirmation. You will be contacted soon to confirm availability.

SCHOOL/GROUP
School/Group Name *
School District/ Campus Location *
State or Federally Funded? *

Is the school state or federally funded?
Number Attending (Excluding Teachers) *

Number attending including students and parents/chaperones.
Grade Level(s) *
Number of Teachers *
CONTACT
Contact Name Contact Name * First Last
Email *
Phone Phone * - ### - ### ####
SCHEDULING
Date Date * / MM / DD YYYY
Time Time * : HH MM AM/PM
Alt. Date Alt. Date / MM / DD YYYY
Time Time : HH MM AM/PM
ADDITIONAL
Do you plan to pay by credit card?

Do you plan to pay by credit card? No Yes
Comments

If splitting into smaller groups, please include a breakdown of what time you want for each show and how many will be in each group.

Science Ambassadors

Science Ambassadors

SCHOOL/GROUP

CONTACT

SCHEDULING

ADDITIONAL