CRPA Order Submission Field Trips @ the Connecticut Science Center Order Type * I would like to bring a group (15+) to the CT Science Center Organization Information Organization Name * Organization Address * Organization Address Organization Address Organization Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Organization Telephone * Personal Information Title * Mr. Mrs. Ms. Mx. Dr. Contact Name * Contact Name First First Last Last Contact Email * Contact Phone * Group Visit Information First Choice Date * Second Choice Date * Third Choice Date * I can arrive at the Science Center as early as * 121234567891011 : 00153045 AMPM I can depart the Science Center as late as * 121234567891011 : 00153045 AMPM My group is arriving by: * Bus Cars/Vans How many buses? * How many cars/vans * What would you like to do when you're at the CT Science Center? General Admission to the Exhibits Yes (Required) Number of Youth (3-17) * Number of Adults (18+) * Will you be eating your lunch during your field trip? * Yes, my group will bring their own individual lunches Yes, my group would like to eat outside on the Plaza No, we will not be eating lunch during our trip Is your group comfortable with potentially sharing lunch room space with other groups? * Yes No Are you interested in adding a Movie onto your visit? * Yes- Please let me know what movie options will be available and I can pick a movie No thank you Movies are an additional $6.00 per person Payment Payment Options (Group Visit) * Invoice me If you are human, leave this field blank. Submit
