Program Request Form for Creepy Critters

Organization requesting a program:

Contact person's name:

Organization's address:

City:

State:

Zip/Postal code:

Contact's work phone:

Contact's cell phone:

Contact's home Phone:

Contact's email

How did you find us?

Program address ( if different than the billing address above):

Program location (must be indoors in heated area if the outside temperature is below 75 degrees - indoors is always preferrable)

Is there a specific topic you would like us to cover during the program?

Do you have any questions or comments?

Submission of this form does not guaranty program availability. You will be contacted to verify your information and discuss availability.

A deposit of $50 dollars will be required to reserve a program. Payment of the balance will be expected on the day of your scheduled visit.