Please print
this form, fill it out, and mail along with your check to:
SCHEDULING COORDINATOR
NC Museum of Natural Sciences
11 West Jones St.
Raleigh, NC 27601-1029
A completed registration form and check for payment are necessary to register for activities that require a fee. Make checks payable to Museum Extension Fund. Information, consent, and health forms will be sent upon acceptance. The Museum can grant refunds only when a cancellation is received at least two weeks before the activity. A $20 processing fee is required for refunds, along with your Social Security number. Questions? Call (919) 733-7450, ext. 555.
| Participant Name (18 or older): | ||
| Participant Name (18 or older): | ||
| Participant Name (18 or older): | ||
| Participant Name (18 or older): | ||
| Parent Name (for minors): | ||
| Child's Name: | Grade/Age: | |
| Child's Name: | Grade/Age: | |
| Address: | ||
| City: | State: | Zip: |
| Phone (home): | Phone (work): | |
| E-mail: | ||
| Membership
#: Exp.
Date: / / (For Friends - click here to join!) |
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Program
# |
Program
Title |
Session
Date(s) |
Fee |
#Registering |
Total
Fee |
|---|---|---|---|---|---|
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Total
Amount Enclosed: |
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