FIU CASE Education Outreach Group Demonstration, Meet an Expert Experience, Labs and Workshops Registration Form

1. CHOOSE YOUR PROGRAM FORMAT

1. CHOOSE YOUR PROGRAM FORMAT Virtual In Person
2. CHOOSE YOUR PROGRAM CATEGORY AND THEME

Options include interactive labs and workshops, a group demonstration, and a meet the expert experience.

PLEASE NOTE:
This form is only to be used for a single day of programming. If you want to reserve programs on multiple days, a form must be filled-out for each individual day. For in person opportunities, the price includes travel up to 30 miles one-way from the FIU MMC or BBC campuses. Additional travel costs may be applied to trips outside this range.
LABS AND WORKSHOPS

All labs and workshops are 45 minutes. There are 12 different themes offered.

For in person labs and workshops the cost is $250 for the first session and 10% off each additional.
For virtual labs and workshops the cost is $200 for the first session and 10% off each additional.

Choose your first lab:
How many sessions of this lab theme would you like to schedule? The maximum is 5 per day.

How many sessions of this lab theme would you like to schedule? The maximum is 5 per day. 1 2 3 4 5
If desired, choose your second lab or workshop theme here to be facilitated on the same day as your first lab or workshop theme.
How many sessions of your second chosen theme would you like on this same day?

How many sessions of your second chosen theme would you like on this same day? 1 2 3 4 5
GROUP DEMONSTRATION

The group demonstration is 45 minutes. There is one theme offered.

For an in person group demonstration the cost is $350 for the first session and 10% off each additional.
For a virtual group demonstration the cost is $265 for the first session and 10% off each additional.

Choose your group demonstration:
How many sessions of this group demonstration would you like to schedule? The maximum is 5 per day.

How many sessions of this group demonstration would you like to schedule? The maximum is 5 per day. 1 2 3 4 5
MEET AN EXPERT

Meet an expert experiences are 1 hour in length.

For an in person meet an expert experience the cost is $450 (max. 30 participants)
For a virtual meet an expert experiences the cost is $400 (max. 30 participants)

Choose your meet an expert experience research theme and speaker options will be presented by the Education Outreach Management Team as your reservation is finalized.
Preferred Date 1 Preferred Date 1 / MM / DD YYYY
Preferred Date 2 Preferred Date 2 / MM / DD YYYY
Preferred Date 3 Preferred Date 3 / MM / DD YYYY
Preferred Start Time
Please note, the earliest to reserve a virtual lab, group demonstration and field trips is 9am. Preferred Start Time
Please note, the earliest to reserve a virtual lab, group demonstration and field trips is 9am. : HH MM AM/PM
How many participants do you anticipate to be in each group?
What is the age demographic/school grade level of your participants?
To ensure that all participants can interact with and enjoy your organization, are there any special needs that we can endeavor to accommodate?
2. SHARE YOUR CONTACT INFORMATION
This will help us organize your program(s).
Organization Name
Organization Address Organization Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Organization Phone Number Organization Phone Number - ### - ### ####
Contact Name
Contact Title/Role
Contact Phone Number Contact Phone Number - ### - ### ####
Contact Email Address
To the best of your knowledge, has CASE Education Outreach served your organization before?

To the best of your knowledge, has CASE Education Outreach served your organization before? Yes No
If you answered "yes" to the above question, please let us know what type of opportunity it was. This can include outreach programs and/or special events.
3. SUBMIT AND RECEIVE INVOICE
Once we receive your reservation, our CASE Education Outreach team will review and process within 24 hours. Before your invoice is submitted, a team member will call you to discuss this form. Electronic credit card payments are preferred but checks are also accepted. A $50 deposit to secure your program date is required. The remainder of your payment must be received 7 business days prior to the facilitation of your event date.

FIU CASE Education Outreach Group Demonstration, Meet an Expert Experience, Labs and Workshops Registration Form

FIU CASE Education Outreach Group Demonstration, Meet an Expert Experience, Labs and Workshops Registration Form

2. CHOOSE YOUR PROGRAM CATEGORY AND THEME

2. SHARE YOUR CONTACT INFORMATION This will help us organize your program(s).

2. SHARE YOUR CONTACT INFORMATION
This will help us organize your program(s).