e-Mission Request Form

Please complete the following school and contact information and submit the form. Once this form has been completed and received by the Program Registrar at the Challenger Learning Center you will be contacted with official confirmation details. If you have any questions, please contact our center, 304-243-8740.

School/Group Information

School/Group Name Street Address

City State

Zip County

District Name

Teacher/Contact Information

First Name Last Name Phone Email

Best Time to Reach You

Mission Information

Mission Mission Curriculum Total Number of Participants

Age Group From Age Group To

Preferred Date Preferred Date (2nd Choice)

Time Zone

Is Daylight Savings Time

Invoicing Contact Information

First Name Last Name Phone Email

Technical Support Contact Information

First Name Last Name Phone Email

e-Mission Request Form

School/Group Information

Teacher/Contact Information

Mission Information

Invoicing Contact Information

Technical Support Contact Information

Questions/Notes