MADlab Reservation Form

Type of Tour: TITLE ONE SCHOOL

Reservations are available for MADlab tour and workshop at 10:30AM, 1:00PM and 3:30PM.

MADlab Date: ______Time:______

Group Type: ___K-12 students ___Special Needs

Grade level: ____ # students in group: ____ # chaperones: ____

______CONTACT NAME

______SCHOOL FULL NAME AND NUMBER

______ADDRESS

______CITY STATE ZIP

______WORK PHONE: HOME PHONE:

CELL PHONE:______FAX NUMBER :______

EMAIL ______

Comments:______CreditCard#:______ex:______CVV#:______Note: A valid credit card is necessary to secure your tour date. Your card will only be charged if you do not allow sufficient notice for cancellation; 10 days or less your card will be charged $50, less than 24 hours notice your card will be charged the full cost of the tour, $105. Free Museum tours for Title One schools, made possible by the Fondation d'entreprse Hermès, with additional support from HSBC Bank USA, N.A.

Date: __/__/__