Outreach Request Form

* Mandatory fields are highlighted and preceded by an asterisk

*Event or Organization name

(something to help us identify the event latter):

Contact Information

*Full Name:

Phone:


*At least one of these, phone or e-mail, is required:

E-mail:



*Description

Include any special comments or information (e.g. if the event must take place on a specific day explain why)




Event Information (stuff that helps us respond and plan faster)

Region:
Age Range:
Preferred Event Date:
Backup Event Date:
Approximate Number of Participants:
Specific Request:
Address: If we are coming to you, or if you need written correspondence, please provide an address:

 

Click the SUBMIT button to send your request.

You should receive an e-mail or phone call from a contact person within a few days. Please contact the astronomy department at 734-764-3440 if you do not get a response or astroweb "at" umich.edu if you experience problems using this form.