Section 1Select Order Type *I would like to bring a group (15+) to the CT Science Center Section 2Organization InformationOrganization Name * Organization Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountryAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabwe Organization Telephone * Organization Fax Personal InformationContact Name * Contact Email * Contact Phone * Contact Extension Section 3 (Group Visit)Group Visit InformationDate Selection Please choose three dates that you would like to visit the CT Science Center 1st Choice Date * 2nd Choice Date 3rd Choice Date Arrival and Departure Time Selection Times are in 15 minute intervals between 8:45 and 5:00pm. Please note that during weekends and off-peak periods, the earliest available time is typically 10:00am. Earliest Arrival Time *010203040506070809101112HH000510152025303540455055MMAMPMAM/PM Latest Departure Time *010203040506070809101112HH000510152025303540455055MMAMPMAM/PM My group is arriving by: *Bus or VanCarsWalking How many buses? *Off-site Bus Parking: $10 per bus per day. Exact Cash or Credit Card accepted at automated pay station. How many cars? *Garage Parking available to vehicles shorter than 8'2".Pricing: $3 for first hour, $2 per additional hour. What would you like to do when you're at the CT Science Center?General Admission to the Exhibits ($13 per person) *Yes (Required) Headcount and Refund Policy Please provide us with an approximate number of the people in your group. The Connecticut Science Center will reserve space and schedule staff based on the quantities you state. It is your responsibility to contact CRPA at least one week in advance for any additions or reductions to your headcount. All reductions must be made AT LEAST one week in advance, or you will be charged the count you originally submitted. Number of Chaperones * Number of Youth (3-17) * Add a 3D Movie? *Yes, add a 3D Movie ($5 add'l per person)No Movie Title Selection *Apollo 11 (starts May 17, 2019)Superpower Dogs (starts June 17, 2019) Add the Butterfly Encounter? *Please note: Adding the Butterfly Encounter requires an arrival time of 10am or earlier.YesNo Would you like to request a space in our Lunch Room? *There is no charge but a reservation is required. If the lunch room is not available, you have the option to eat outside on the Riverfront Plaza which is directly adjacent to the Science Center (weather permitting!).Yes, we will bring our own lunch.Yes, and we'd like to purchase Boxed Lunches from SUBWAY ($7.50 per box)No, but we would like to bring our own lunch and eat on Riverfront Plaza.No Section 3 (Good Any Day Tickets)Ticket InformationInformation You may begin selling Good Any Day tickets at any point during the year. You do not have to sign up for the program by the start date in order to participate. These time periods are for reconciliation purposes. If you join the program in the middle of a reconciliation period, please be aware that your payment and returned tickets are still due back at the CRPA office by the end date of the period. Please indicate in which period you will be selling these tickets *CRPA will be reconciling ticket order bi-annually. You must submit payment with any unsold tickets by the ending date of that period.January 1st - May 1stMay 1st - December 1st Other Additional terms and conditions Ticket sales may begin as soon as you receive tickets. All unused tickets must be returned and paid for by the end of the reconciliation period indicated above THIS IS A FIRM DATE. No tickets will be accepted after that date, and no refunds will be issued for any tickets returned after that date. No refunds will be issued for tickets returned without stubs. These tickets should be treated like cash. You are responsible for any tickets purchased until they are returned to the CRPA office. CRPA recommends any mailing be via certified mail, express mail, UPS, or FedEx. Quantity of TicketsGeneral Admission (Admission to 150+ exhibits plus Travelling Exhibit) *CRPA Special Pricing: Adults and Youth are the same price ($13.50) PostagePlease select Postage Type *Certified Mail ($8)Pick up at CRPA Office (Free) Section 4Payment Options (Group Visit) *Invoice mePurchase OrderCredit Card Payment Options (Good Any Day Tickets) *Invoice MePurchase OrderI will be sending in an organization check by May 1st or December 1st (depending on reconciliation period) Purchase Order *Please enter your Purchase Order number Credit Card Instructions After you are invoiced, you must call CRPA and provide a Credit Card number. Please verify you are humanPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank