Glendale Community College : Alumni Form

Survey/Form Review

GCC Science Center Reservation Form

Please Note: (*) indicates responses are required.

DATE & TIME

*Date: (mm/dd/yyyy)

Time [9:30am-12pm]

Time [Other Specify]

In the case of a large group requiring two separate visits, please indicate the second date here:

Second Date: (mm/dd/yyyy)

Time [9:30am-12pm]

Time [Other Specify]

I have checked the calendar for available dates.*

Yes

About Your Group

School or Organization*:

District or Agency:

Address*:

City*:

Zip*:

Phone*:

FAX:

Email (principal/secretary)*:

Lead Person Name*:

Lead Person Email*:

Lead Person Phone Number:

Emergency Contact Name*:

Emergency Contact Phone*:

Grade Level(s) Attending*:

Number of Students Attending*:

Number of Adults*:

Number of Cars Requesting "Visitor" Parking Passes:

Have you visited our facility before?

Yes

Lunch

Yes

Special Considerations for Your Group

Please describe:

Planetarium Presentation Requested

Please tell us which of the presentations listed on our web site you want for your group. Note that most of our presentations encourage audience participation, and so we are quite flexible and can accommodate special requests. With this thought in mind, tell us also if there are any particular topics that you would like the Planetarium staff to cover for your group? Please try to be specific:

Science Center Activity Requested

Please tell us which of the activities listed on our web site you want for your group:

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