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: 48 hours is required for refund of fees. $5 processing fee not refunded under any circumstances. The VDM reserves the right to cancel programs with insufficient enrollment, and will fully refund fee.