Koshland Science Museum - Facility Request Form

Request Form

Are cows partly responsible for global warming?

Global warming will impact ecosystems around the world. Learn how Adélie penguins are affected by the warming.

	EVENTS

Facility Use Request Form

Print a PDF version of this form to submit via fax or mail. Required fields are starred.

* Organization Name:
* Contact Name:
* Title:
* Address:
* City/State/Zip:
* Telephone:
* Fax:
* Email:
* Website:
*Please choose the type of event you wish to hold in the museum (You may check more than one).
Reception
Sit-down Dinner
Meeting
Lecture
What is the specific purpose of the event you wish to hold (e.g., leadership dinner, roundtable discussion, etc)?
Please specify.
Please list, in order of preference, the date and time you wish to hold your event. We will contact you within two (2) business days regarding availablity and event details.
* Date 1:	/ / (Month/Day/Year)
*1st Choice of Time
*2nd Choice of Time
3rd Choice of Time
Date 2:	/ / (Month/Day/Year)
1st Choice of Time
2nd Choice of Time
3rd Choice of Time

*Estimated Attendance

	Please note: The maximum attendance at events is 200 individuals.

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