Contact Name*

Organization Name*

Address

City

State

ZIP

Phone*

Email*

Date Requested

First Choice

Second Choice

Third Choice

Organization Type

School	Library
Senior Center	Other

Audience Age

Audience Size (How many TOTAL people do you expect to attend programs? Do not include Staff members/Chaperones in your count.)

Which planetarium? (Our small dome holds about 25 people, needs at least 20 feet by 20 feet of floor space and 11 feet of ceiling clearance. The large dome holds about 50 people, needs at least 25 feet by 25 feet of floor space and 13 feet of ceiling clearance. The domes can not be set up outdoors.)

Large Dome	Small Dome
Not Sure

What is the time range during which we can hold programs?

From am pm

To am pm

Program(s) Requested

... and you can type below also.

Coupon Code

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