The Leonardo

SIGN-UP FOR LOW—SCIENCE

Please take a few minutes to fill out this sign up form. The information you provide will help us to plan a successful visit to your school. Shortly after you submit this form, we'll contact you to begin the arrangements. ABOUT YOU
Your Name	Your Title
EMAIL ADDRESS	YOUR PHONE NUMBER
ABOUT YOUR SCHOOL
Name of your School	School District	School Phone
ADDRESS 1		ADDRESS 2
CITY	STATE	ZIP
TYPE OF SCHOOL	SCHEDULE TYPE	NUMBER OF STUDENTS
SCHEDULE PREFERENCE We'll try to accommodate the schedule you request, but to make sure we can help, please supply a second and third schedule choice. Leonardo On Wheels usually starts on a Monday and runs to the following Friday.
FIRST CHOICE	SECOND CHOICE	THIRD CHOICE
IMPORTANT VISIT DETAILS
SETUP LOCATION	ARE THERE ELECTRICAL OUTLETS? Yes No
ANY SPACE CONFLICTS THAT WE SHOULD BE AWARE OF?
COMMUNITY NIGHT Would you be interested in hosting a community night where parents and other members of the community can visit the exhibit during an evening? Yes No

ANY OTHER INFORMATION THAT WE SHOULD BE AWARE OF?

THANKS FOR TAKING THE TIME TO FILL OUT THIS FORM. We really enjoy helping kids discover science and look forward to coming to your school. Please click the submit button and we'll get started planning your visit.