Koshland Science Museum - Visitor Information

Group Visit Request Form

Reservation Confirmation

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	VISITOR INFO

Group Visit Request Form

Print a PDF version of this form to submit via fax or mail.

For structured field trips, please complete the Field Trip Request Form.

Required fields are starred.

* Organization/ Company/ School Name:
* Contact Name/Title:
* Address:
* City/State/Zip:
* Telephone:
* Fax:
* Email:
Please list, in order of preference, the date and time your group would like to visit. We will contact you within two (2) business days to confirm available dates.
* Date 1:	/ / (Month/Day/Year)
* Times:	* 1
	* 2
	* 3
Date 2:	/ / (Month/Day/Year)
Times:	1
	2
	3
Date 3:	/ / (Month/Day/Year)
Times:	1
	2
	3

Name of Group (if different from above):
Name of contact to arrive with group (if different from above):
* Number of paying adults:
* Number of paying seniors/military:
* Number of tour guides (eligible for complimentary admission):
* Number of paying students:
* Number of chaperones (eligible for complimentary admission):
The museum requires one (1) chaperone for every ten (10) students . Additional chaperones will be charged admission.

Number of motorcoaches:

*Special Needs/Requests, please Check One:	No special needs, self-guided
	Museum introduction and orientation
	Self-guided materials/worksheets (This is recommended for all student groups)

Other, please specify:

Payment Requirement:When your group's tour date is confirmed, full admission payment is required to finalize your reservation.

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