Reservation Form
* indicates a required field
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School Name:
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Address:
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City:
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State:
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Zip:
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County:
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District:
Teacher/Mission Information
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Teacher's Name:
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Phone:
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Email:
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Good time to contact teacher:
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e-Lab Choice:
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Grade Level(s):
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Number of students:
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Preferred Mission Schedule:
(please provide first two choices below)
*
1
st
choice
Date:
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Time:
*
2
nd
choice
Date:
*
Time:
Electricity
Chemical Reactions
Matter Matters
DNA
Seasons
Science Magic
Volcanoes
Electromagnetic Spectrum
Kitchen Chemistry
Newton's Law I
Newton's Law II
Newton's Law III
Invoicing Information
Send invoice to:
Attn:
Email:
Address:
City:
State:
Zip:
Technical Information
Technology Coordinator:
Phone:
Email:
Good time to contact:
Please indicate how you will be connecting with the Challenger Learning Center
IP with Video Conferencing Equipment:
IP with Computer & Webcam, (SKYPE, Google Hangouts, etc):