LASM Discovery Dome Reservation Form 2010–2011

Register online below or download a registration form and fax it to LASM at 225-214-1445.
ONLINE INSTRUCTIONS
1. Complete the reservation request form with your information and press the SEND button.
2. Please complete a separate form for each visit.
3. *Items marked with a red asterisk are required.
4. After we receive your form, you will receive a confirmation stating the date, time, schedule, cost per person, and deposit information. Please allow up to three business days to receive your confirmation.
5. Your reservation is NOT final until you fax a SIGNED copy of your confirmation to LASM at 225-214-1445.
   
SCHOOL INFORMATION
*School Name  
*School Address  
 
*City  
*State  
*Zip Code  
*Parish  
*School Phone Number  
School Fax Number  
   
*Teacher/Contact Person  
*Contact Phone Number  
Alternate Phone Number  
*Teacher E-mail  
   
*Number of Students   *Grade
*Number of Teachers  
   
Special Needs   Yes or No  Do you have student(s) with special needs?
  If yes, please let us know what special accommodations we should make:
 
   
DATE OF VISIT
4 presentations / max. 3 hours   $350
8 presentations / max. 5 hours   $500
Note: A $.40 per mile round trip fee will be assessed for all areas outside East Baton Rouge Parish.
   
*Requested Date  
1st Choice  		  (mm/dd/yyyy)
 
*Alternate Date  
2nd Choice  		  (mm/dd/yyyy)
   
*Alternate Date  
3rd Choice  		  (mm/dd/yyyy)
   
*Requested   
Arrival Time  
   
*Requested  
Departure Time  
   
Do you wish to schedule multiple days   Yes or No  
*Number of Days   Multiple dates may be scheduled for large groups. If you wish to schedule multiple dates, please state the number of days.
 
PROGRAM TITLE
Select your presentation     
   
Additional Comments: 
 

We recommend that you print this page before clicking the SEND button.