Virginia Discovery Museum

Program Registration Form

Please print out and complete this form for each program registration. Mail to VDM Programs, PO Box 1128, Charlottesville, VA 22902

Child’s Name ________________________________ Child’s Age ______  Program________________ Date________ Cost _____

Adult’s Name ________________________________ Member:  Yes    No

Address_____________________________________________________________

              _____________________________________________________________________

Phone ________________________      Email______________________________

Credit Card #_________________________________

Exp. date ______________   VCode_______________ (3 numbers on back of card)

Signature____________________________________

Cancellation Policy: One week's notice is required for a full refund of all fees minus a $5 Processing Fee.  If notification is less than a week before the start of the program, VDM will transfer the fee amount to another Museum purchase of your choice.  The VDM reserves the right to cancel programs with insufficient enrollment and will fully refund fees from those programs.