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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 vancouver@madsciencebc.com or call (604)591-9115



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.

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

Start Time

Teacher/Grade

# Of Students Room #

1.

2.

3.

4.

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Additional scheduling details:

a

PAYMENT INFORMATION

Address Invoice To:

This form is to request a Mad Science workshop.
Clicking on the submit button will send your request to Mad Science of Vancouver and Area.

Please do not submit this form for an inquiry only.
Send your inquiries to vancouver@madsciencebc.comor call (604)591-9115


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