WOW School Request

Contact information for the person requesting:

First and last name

Email

Phone

Full school name and/or requesting organization:

Address of the school or location where the WOW is requested:

Street Address

City

State

Zip Code

Top 3 dates requested:

First Choice

Second Choice

What grade levels are you requesting? (The WOW is designed primarily for 4th, 5th, and 6th grades)

Expected number of classes:

Average number of students per class:

What time does the school day start?

What time does the school day end?

How long are class periods?

Is there an outdoor space that's level, paved, within 200 feet of electricity, and has room for a truck and trailer that take up 50 feet in length when parked? Is that space at least 12 feet in width? It must be parked on a flat, level surface. All of these things are necessary for a WOW visit.

Yes
No

I understand that the WOW is a vehicle that has no water, heating, air conditioning and cannot be used in the rain.

Yes, I acknowledge the above statement.

Please attach a map, showing us where you plan to park the WOW. You can use Google Earth and mark it. Keep in mind the space and electrical requirements as stated in the previous question.

Payment information part 1:

Name of requesting person and organization

Mailing address

Telephone number

Fax number if available

Federal ID Number (FEIN)

Email address

Payment information part 2:

Complete Form W-9 from the IRS https://www.irs.gov/pub/irs-pdf/fw9.pdf and upload:

I understand that my school or organization will not be billed until AFTER the event.

Yes, I acknowledge the statement above.

Do we have permission to take photographs and or video of your staff and students during our visit and while they are interacting with our staff and the WOW? The photos may be used for educational and promotional purposes of the University of Memphis, and will not be produced for profit. No minor will be identified. If there is anyone who doesn't want to be photographed or videoed, we will abide by their requests.

Yes
No

Is there anything else we need to know, such as another contact, etc.?