Reservation Request Form Challenger Learning Center of the Capital Region at miSci Spring & Summer 2015 Complete this form and email to [email protected] or fax to 518-382-7893. A reservationist will call you to book your trip. Please let us know when to call you: date ________________ time ________________ Please note: Your mission is not booked until you receive a confirmation email from miSci. GROUP INFORMATION REQUESTED PROGRAMS School / Organization Name Program Date (please provide 3 choices) ________________________________________________ Teacher / Contact Name 1st choice ________________________________________________ Address_________________________________________ City_____________________________________________ State__________ Zip_______________________________ Phone (_____)____________________________________ Fax (____)________________________________________ District _________________________________________ County _________________________________________ E-mail Address ____________________________________ Grade / Age Level __________________________________ Number of Students _______ Number of Adults _______ (Maximum 30 students; at least 1 adult / every 6 students) TEACHER MISSION PREP WORKSHOP (REQUIRED) Prior to your mission, you will attend a Teacher Mission Prep Workshop. Date will be coordinate when your reservation is confirmed. 2nd choice 3rd choice Mission / Time Rendezvous with a Comet (Grades 5-12) 9 - 11:30am 12:30 - 3pm Exploration Station (Grades 3 - 4) 9 - 10:30am 12 - 1:30pm Cosmic Kids (Grades 1 - 2) 9 - 11am 12 - 2pm Junior Astronauts (Grades preK - K) Call for times 2 missions may be scheduled for 2 groups from your school/organization sharing the same day. Afterschool & Weekends available on request. Additional Programs Planetarium Show Museum Time (self-guided) Interactive Science Demo Hands-on Science Exploration Please note: miSci is an active science center. We strive to fulfill our mission by serving people from throughout the region and beyond every day; we may welcome multiple groups on your visit day. miSci Promotional Photography Policy By entering miSci’s facility and/or participating in a miSci activity or event, you consent and authorize without restriction or compensation to the possible use of your and your accompanying group’s image appearing in photograph, audio, video, or other formats which may be included in future media or marketing. For miSci Use Booked Grant Requesting Info Check Purchase Order Initials Cash