Cosmic Explorer Workshops Registration

Which session(s) do you wish to attend? I Want to be an Astronaut, Sunday, 12/13/2009, 2-4 pm
Fly Me to the Moon, Sunday, 1/10/2010, 2-4 pm
Solar System Adventures, Sunday, 2/14/2010, 2-4 pm
Stories in the Skies, Sunday, 3/14/2010, 2-4 pm
Earth, Sunday, 4/11/2010, 2-4 pm

Are you already a Gheens Science Hall & Rauch Planetarium Member?
Yes No

Sign up for a membership if you wish to become a member and receive discounts on workshops and camps as well as free admission to regular planetarium shows.

Please let us know how you heard about the Cosmic Explorer Workshops.

Parent/Guardian Information

First Name

Last Name

Email Address

Phone Number [###-###-####]

Street Address 1

Street Address 2 [optional]

City

State

Zip Code

Child Information

First Name

Last Name

Age

Grade Level

List any special needs we should be aware of. [optional]

Child 2 Information

Which session(s) do you wish the second child to attend? I Want to be an Astronaut, Sunday, 12/13/2009, 2-4 pm
Fly Me to the Moon, Sunday, 1/10/2010, 2-4 pm
Solar System Adventures, Sunday, 2/14/2010, 2-4 pm
Stories in the Skies, Sunday, 3/14/2010, 2-4 pm
Earth, Sunday, 4/11/2010, 2-4 pm

First Name

Last Name

Age

Grade Level

List any special needs we should be aware of. [optional]