1600 Ken Thompson Pkwy.

Sarasota, FL 34236

Fax: 941-388-4381

Email:

Website: www.mote.org/overnights
SeaSnooze Overnight Girl Scout Registration

Saturday, February 2, 2013 6:30 p.m. – 8:30 a.m.

All reservations must be made on this form only and faxed, emailed, or mailed to the address listed above. Program times and dates will be assigned as available. You will receive written confirmation by e-mail or mail from Mote staff. Please make a copy of this form for your own records. Thank you! Questions? 941-388-4441 ext. 264 or email:

GIRL SCOUT NAME: TROOP #:

CONTACT PERSON: GROUP LEADER:

PHONE NUMBER: ( ) BEST TIME TO CALL:

ALTERNATE PHONE NUMBER: ( ) BEST TIME TO CALL: ______

BILLING ADDRESS: ______

CITY: STATE: ___ ZIP: ___ COUNTY: ______

EMAIL ADDRESS: AGE OF SCOUT(S): ______

# OF ADULT CHAPERONES: (1 PER 5 STUDENTS IS REQUIRED & ADMITTED FREE [Additional chaperones are $15 per person]

ANY SPECIAL NEEDS, ETC.? ______

Check which box applies to your Girl Scout / Daisy / *Mote educators will lead fun and educational activities throughout the evening based on marine science that align with Girl Scouts National Leadership Journeys. Bring Journey books with you.
Brownie
Junior
Cadette

Payment Information:

Program Cost: $42 per Scout, 1 chaperone per 5 Scouts required and admitted free, extra chaperones $15. Each Scout must have at least one adult guardian present at the event. Cost includes all meals and snacks in addition to a Mote Marine Laboratory Scout Patch.

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.

FOR SEASNOOZES, PLEASE NOTE THE FOLLOWING: Pizza Dinner, Coral Reef Dessert, and Continental Breakfast: PROVIDED

After you have filled out this form, email, mail or fax it to the above address. We will send you confirmation materials including a schedule and a letter of expectations for families. We look forward to seeing you February 2!