High-Tech Productions.com Science & Technology Center Application
Please fill out this form and mail it together with a
floppy disc or CD-Rom with pictures of the building/facility to:
High-Tech Productions,  Science & Tech Centers, POB 3506, Boca Raton, FL 33427

Please print clearly

Name_______________________________________   Position_______________________

Organization_________________________________________________________________

Phone # (          ) ____________   Fax #_____________   E-Mail_______________________

Address_____________________     City_________________     State____     Zip________

Building Size (Interior Square Feet)_______________     Winterized (Yes/No)____________

Is Facility Open All Year?__________      How Many Visit the Facility Per Week_________

Does Building Have Electricity___________    Does Building Have Internet Access________

Does the Facility Currently Have a Name?____________   If so, What__________________

Is the Facility Currently In Use?______________   When Will it be Available____/____/____

Please Give Description of Building/Room_________________________________________

____________________________________________________________________________

____________________________________________________________________________

    On behalf of the above named School/Scouting Council, I hereby agree to all of the terms & conditions set forth with regards to receiving a High-Tech Productions.com Science & Technology Center at our School or Scout Camp.

Signature____________________________________                 Date__________________