Wufoo

ISSM Field Trip Inquiry Form

Please complete this form to inquire about visiting Imagination Station Science Museum in Wilson, North Carolina.

*Completion of this form only begins the reservation process. We will contact you and let you know what dates are available.

Feel free to call Crystal Williams at 252-291-5113 for more information.

School or Group Name

Please tell us what school or group you are with.
Contact Person (your name) * First Last
Contact Telephone Number * - (###) - ### ####
Please put the telephone number that we may reach you between the hours of 9 am - 5 pm, Monday - Friday.
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Please provide address where your confirmation packet will be mailed.
Your Email Address *

Please input your email address.
I would like to subscribe to Imagination Station News and Events e-mail.
Date you are interested in visiting ISSM? * / MM / DD YYYY
Please look at your calendar and tell us the day you are interested in visiting Imagination Station Science Museum.
Grade Level

What grade is your class or group?
Number of Visitors?

Group rates begin at a minimum of 10 visitors.
Program Choice

Please tell us what program you are interested in receiving while your group is visiting ISSM. Also remember that Discovery Classes (DC) are small group inquiry based (hands-on) classes and require more time to complete. Court Room (CR) Programs are more flexible and can facilitate 60 children at one time.
What time you would like to visit ISSM? : HH : MM SS AM/PM
Please tell us when you plan to arrive at ISSM on the day of your visit.
Comments

Use this space to tell us anything we may need to know. You can also include alternate dates and times here.
Do Not Fill This Out