Please enter all information completely and accurately (the more you tell us now, the less we'll have to ask for later.) After that, you can submit the form with the click of a button or print it out and mail it in.

Visit Type: School Other

Please note that REQUIRED FIELDS are marked with §

Teacher Name §
School Name,Address §
E-Mail Address §
Work Phone §
Home Phone
FAX
Time(s) we can call you to discuss your Cosmic Adventures visit (please don't say, "Anytime").
Student Grade level(s) attending the presentations:
Please list the names of any other teachers who will be involved in this visit

Date(s) Needed § -- Providing us with multiple dates will expedite scheduling of your visit.
First Choice:	Second Choice:	Third Choice:

Lesson Plan(s) Requested:

All Ages (Pre-K - Adult)	Kindergarten - Grade 2	Grades 3-5
A Brief Tour of the Universe The Sky Tonight The Star of Bethlehem	Moving Right Along Sky Stories What's Up	Moons of the Solar System Planets Star Quest StellarLunar
Grades 4-8	Grades 6-8	Grades 9-12
The Astronomy of Lewis & Clark	Mars Stellar Navigation Solstice and Equinox World in Motion	Astrology: Fact or Fiction How do we Know? Hubble Space Telescope
Other Activity:

What is the START TIME of the FIRST presentation? §
What is the END TIME of the LAST presentation? §
How many TOTAL Students will be viewing the presentations? §
How many TOTAL CLASSES will be viewing the presentations? §

Comments/Questions For Cosmic Adventures

This form can be mailed to:

Cosmic Adventures, LLC P.O. Box 1213 Frederick, MD 21702

info@cosmic-adventures.com Phone: 301-676-0971