Buffalo Museum of Science

Camp-In

Registration Form

Camp-In Date: ________________

Contact’s Name: ______________________________________________________________

Mailing Address: ______________________________________________________________

City: ______________________________ State: ______ Zip: _______________

Day Phone #: _______________________ Evening or Cell Phone #: _________________

Email Address: ________________________________________________________________

Number of Children ______ @ $30 each Total ____________

Number of Adults ______ @ $22 each Total ____________

Amount of Full Payment ___________________

CREDIT CARD INFORMATION:

Please check one: ___Master Card ___Visa ___Discover

Name on Card (please print):____________________________________________

Credit Card Number: ____________________________________

Expiration Date: ______ 3 Digit Security Code Located on Back of Card: ______

Signature (required for credit card) _______________________________________________

For Fax Registration: (716) 895-8739 For Phone Registration: (716) 896-5200 x345

Please make check payable to: Buffalo Museum of Science

Camp-In Program

1020 Humboldt Parkway

Buffalo, NY 14211-1293

Please indicate on the check: group name and date of Camp-In

REGISTRATION / PAYMENT / CANCELLATION / REFUND POLICY

· Fax/email/mail this form with your full payment to guarantee your date

· Refunds, of the balance, are provided if notified at least 5 business days before the date of the Camp-In. Refunds will not be available for registrants who choose not to attend the event.

· The Buffalo Museum of Science reserves the right to cancel at any time. In the event the Museum cancels the program, a full refund will be issued if the Camp-In is unable to be rescheduled within the 2017-18 Camp-In season.