Challenger Learning Center New Mexico - Albuquerque, New Mexico

LAUNCH INTO LEARNING MISSION REGISTRATION FORM

Note: positions in programs are not guaranteed until payment has been received by CLCNM.
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Mission Information All Fields Required

Mission *

Date Requested *

Rendezvous With A Comet Schedule: Monday – Friday

Micronaut Option One and Two Schedule: Tuesday or Thursday

Teacher Information Complete All That Apply

Prior Training

Grade Level

Other

Organization Information All Fields Required

Organization Name *

District *

Note: enter "NA" if this does not apply

Address *

City *

State *

Zip *

Contact Person *

Teacher or Leader *

School Phone *

Home Phone *

Fax *

Email *

Approval By*

Note: you must provide proof of approval at time of payment

Purchase Order *

Note: enter "NA" if this does not apply

Attendees All Fields Required

Number of Adults *

Number of Children *

Additional Information Please Complete the Following Question

How did you learn
about CLCNM?

If you selected "Other",
please provide a brief
explanation

Security Required

Security Code *

Enter Security Code

Payment Information

• Call (505) 248-1776 to confirm your date and time, and to make payment arrangements.
• A $100 deposit will hold your date, with the balance due 2 weeks prior to your mission date.

CLICK THE SUBMIT FORM BUTTON BELOW TO COMPLETE YOUR REGISTRATION FORM

Registration Form

LAUNCH INTO LEARNING MISSION REGISTRATION FORM