MEMA Tour/School Visit Request Form
This form must be completed for all field trip requests. Average presentation last around 30 minutes to one hour. Please keep in mind that in the event of facility activation, your reservation may need to be rescheduled. Thank you.
Type of Tour
*
MEMA Tour (Pearl, MS)
MEMA On-Site Visit (Your Location)
School Name
*
EX: University of Mize
School Phone Number
*
Main Line
Teacher Name
*
First Name
Last Name
Teacher Phone Number
Requestor Number
Teacher E-mail
*
example@example.com
GRADE
*
1
2
3
4
5
6
7
8
9
10
11
12
Undergraduate
Graduate
Technical
Number of Participants
*
Requested Date & Time
Please select two options
*
-
Month
-
Day
Year
Date
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
*
-
Month
-
Day
Year
Date
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Transportation
Bus, personal, etc.
Number of Vehicles
Topic requests
Instructions for Visiting School
Additional Information for visiting MEMA*
*Please be sure to note any special needs n this field
Submit
Should be Empty: