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2. Please complete the following information.

4. Contact First & Last Name*
5. Organization Name*
7. Address*
9. Address Line 2
11. Phone number:*
12. Email address:*
14. City*
15. State*
16. Zip*
18. Type of Group*
    -- Select One --K-12 SchoolHomesechoolPreschool/Daycare UniversityScoutsAdult/Senior Business GroupOther
19. Number of Youth in Group*
20. Number of Adults in Group*
22. Type of Program*

    1. In person
    2. Virtual
    3. Not sure
23. Length of Requested Program*

    1. 30-minute
    2. 60 minute
    3. Not sure
25. Education Program Descriptions

    Access program descriptions.

27. Available Programs

    1. Hands-On Flint Hills (K through 12)
    2. Engineer It!: Assembly Line (K through 2nd)
    3. Rockin' Fossils (3rd through 5th)
    4. Cowboys and Cattle Cars (see note) (3rd through 5th)
    5. Engineer It!: Windmills (see note) (3rd-5th)
    6. A Rocky Start (6th through 8th)
    7. The Natural Economy (see note) (6th through 8th)
    8. Engineer It!: Prosthetic Leg (6th through 8th)
    9. A Rocky Start II (9th to Adult)
    10. The Natural Economy II (9th to Adult)
    11. Adult Lecture (call for details)

    Please select any programs that interest you.

    Note: fully developed lesson plan available, including pre and post-visit activities.

29. First Choice Date & Time*
    First Choice Date & Time

    First Choice Date & Time
30. Second Choice Date & Time
    Second Choice Date & Time

    Second Choice Date & Time
31. Third Choice Date & Time*
    Third Choice Date & Time

    Third Choice Date & Time
33. Do you have any special requirements?
35. How would you like to receive your confirmation packet?*

    1. Email
    2. USPS (mail)
36. Picture Permission

    We like to take a picture of each group, if possible, for potential marketing, especially on social media. Before we arrive, please check to see if anyone in your group does not have permission to be photographed for marketing purposes. Thank you.

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38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field