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Parent Workshop Certificate Request Form

Please use this form to purchase a Workshop Certificate for your child's class. Once we have processed your request, we will email you a Workshop Certificate, valid for one In-Class Workshop including all materials* and travel (for up to 32 students).

The total amount charged to your credit card will be $175.

Name:
Child's School:
Phone Number:
Billing Address:
Email:



Type of Card:
Credit Card #:
Expiration Date:
Name on Card:


Promo Code:

In order to protect our website and prevent spam, we need to verify that this form is submitted by a human and not a computer program.
Please complete this simple addition:

* Additional material fee applies to select workshops. San Diego County only. Valid for 32 kids. Appropriate for grades K-6.

Questions? Contact Mad Science at:
(858) 505-4880
mail@madsciencesd.com
SanDiego.MadScience.org


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