Outreach Sign-Up Form

This form is for our mailing list only. You school will not be visited this year, but you will receive our mailing next January.

If you have received an email from us, you are already on our mailing list and do not need to fill out this form. To respond to our email, please use the link in the email to access our Reply Form.

Please fill out this form completely and you will be placed on our mailing list. Typically, our mailings occur in January, and all of the shows are done during the spring (February - June).

Please note that the MIT Chemistry Outreach Program volunteers are only able to visit schools within a 90 minute drive from Boston. If you are located farther than 90 minutes from Boston, feel free to browse the web site or email us directly at chem-outreach@mit.edu but please do not fill out this form because you will not be placed on our mailing list.

Please provide the following contact information (all fields are required):

First Name

Last Name

School

Street Address

Address (cont.)

City

State **We cannot visit states outside New England**

Zip Code

Phone

E-mail

Has the outreach program visited your school before? If so, when?

How did you hear about the MIT Chemistry Outreach Program? Any questions or comments?

Please send email to chem-outreach@mit.edu with questions or comments about this web site.