1600 Ken Thompson Pkwy.

Sarasota, FL 34236

Fax: 941-388-4381

www.mote.org/education

Penguin Island Pajama Party Registration Form

Name of Adult Participants

Name of Child Participants (ages 7 and above) Age: ______Age: ______

Age: ______

Special Needs / Dietary Needs:

Contact Person:

E-mail:

Phone Number: Best ( ) Alternate ( )

Billing Address: City: ______State: ______Zip: ______

Mailing Address: City: State: Zip:

Media Release Form Information

Mote educators will take pictures throughout the event and post them on a password-protected Web site for families to enjoy. You may mail in the completed forms with all participants names or bring them with you on the day of the event.

Program Selection:

(Please note that our programs do not involved physical contact with or personal interaction with out exhibit animals.)

SeaSnooze Overnight Program
Penguin Island Pajama Party / $80 per pair (adult and child)
$35 per extra person (adult or child)
$140 for a Family Package of 4 participants
(Member and Non-member same price) / Total: ______

Payment Information

Check Please make checks payable to Mote Marine Laboratory. Amount Enclosed: Check #:

Credit Card Please circle the credit card type. VISA MASTER CARD AMERICAN EXPRESS DISCOVER

Card #: Expiration Date: ____/____ (mm/yy) Amount:

Name as it appears on card: Signature:

MAIL: Mote Marine Laboratory, Attn: Miranda Wrobel, 1600 Ken Thompson Parkway, Sarasota, FL 34236

FAX & E-MAIL (Credit Card payment only): (941) 388-4381/

Cancellation Policy: There are no refunds for Mote Education programs unless Mote cancels the program. If you provide notice of cancellation, or a change in the number of students attending more than five days before the program date, we will credit your payment to a future program. If within five days of the program, you cancel or change the number of students attending, or if you fail to show up, you will be charged in full for the program.

Mote Education Internal Use Only:
Date received ______Initials ____ Amount: ______Confirmation Sent: ______
___ Participated in program ___ Cancelled with 24-hour Notice ___ Cancelled without 24-hour Notice