STEM with DCM Reservation Request for Groups

School/Organization/Group Information

School/Organization/Group Name*

School District (if applicable)

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Contact Information

Contact Person*

First Last

Contact Person Title

Contact Phone*

Contact Email**

Request Information

Grade Level**

Number of Students**

Number of Educators**

Number of Adults (not educators)**

Choose A STEM with DCM Lab**

Sound All Around

Wings & Things

Build A Bridge

Create A Creature

The Art of Shapes

Mystery of the Suspicious Substance

Nature's Adventure

Requested Date (1st Choice)**

Requested Date (2nd Choice)**

Requested Start Time*

Chosen Format**

At DCM

In Your Classroom

Would you like to include a Field Trip with your lab? (For Labs at DCM Only)

Yes

No

Additional Questions/Requests

Do you have any additional questions or requests?

STEM with DCM Reservation Request for Groups