SciGirls Registration

Question details

First Name (Required)

Enter the child's first name.

Last Name (Required)

Enter the child's last name.

Age (Required)

Choose the child's age.

-- Please, select -- 8 9 10 11 12 13 14 Other

enter if "Other"

Accompanying Adult Name (Required)

Enter the name of the adult staying with the child for this activity.

Street address

Enter your address.

City

Enter your city.

County of Residence

Please enter your county of residence

State

Enter your state.

Zip Code

Enter your zip code.

Phone number

Please enter a phone number.

Email Address

Please enter an email address.

Choose the SciGirls session for which you are registering (Required)

SciGirls is held on the LAST TUESDAY of the month offered. You may register for an avaialble date at any time.

-- Please, select -- April 24, 2012 Chemistry of Food May 22, 2012 Chemistry of Food Part II September 25, 2012 - Light Pollution October 30, 2012 - TBA November 27, 2012 - TBA