Koshland Science Museum - Facility Request Form

Request Form

How can bacteria survive after being exposed to antibiotics?

Under ideal conditions, how often can a population of bacteria double?

	EVENTS

Facility Use Request Form

Print a PDF version of this form to submit via fax or mail. Required fields are starred.

* Organization Name:
Please note: The Marian Koshland Science Museum is available by reservation to other non-profit organizations only.
* Contact Name:
* Title:
* Address:
* City/State/Zip:
* Telephone:
* Fax:
* Email:
* Website:
*Please choose the type of event you wish to hold in the museum (You may check more than one).
Reception
Sit-down Dinner
Meeting
What is the specific purpose of the event you wish to hold (e.g., leadership dinner, roundtable discussion, etc)?
Please specify.
Please list, in order of preference, the date and time you wish to hold your event. We will contact you within two (2) business days regarding availablity and event details.
* Date 1:	/ / (Month/Day/Year)
*1st Choice of Time
*2nd Choice of Time
3rd Choice of Time
*Date 2:	/ / (Month/Day/Year)
*1st Choice of Time
*2nd Choice of Time
3rd Choice of Time

*Estimated Attendance
*Any audio/visual	Yes
needs?	No
If yes, list briefly.

*Please list background and or mission statement for your organization.

How did you hear about the museum?

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