Traveling Science Inquiry Form

Contact our Outreach Coordinator at or 313.577.8400, ext. 238 for additional information and reservations. Note: If you are using Internet Explorer, please consider using a different browser to complete this form as certain fields are not optimized for Internet Explorer.

School/Organization Name (required)

Organization Type (required)

Contact Name (required)

Contact Title

What fields of study most interest your group? (Select all that apply)
AstronomyBiologyChemistryPhysicsEarth ScienceEngineeringTechnologyMathematicsOther

What types of programs are you interested in? (Select all that apply)
Hands-on WorkshopsSTARLABGroup PresentationsScience FestivalsOther

Contact Email (required)

Contact Phone Number (required)

Event Address (required)

Street Address (required):

Address Line 2

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Zip Code (required):

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Best Day(s)/Time(s) for Contact:

Grade Levels:

All AgesPre-KindergartenKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th Grade

First Date Choice (required)

Second Date Choice (required)

Third Date Choice

How many students will be in attendance?

How did you hear about us?


Thank you for your purchase. We look forward to seeing you at MiSci soon.