Donation Form - End Of Year Giving

Name(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

In Honor Of

Comment

Donation Amount

Other Amount

Campus(Required)

Discovery Cube OC

Discovery Cube LA

Total

Enter Credit Card(Required)

Card Details

Cardholder Name

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Payment Type

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Source

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Name

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Member Event Registration Form: Science Night Live

"*" indicates required fields

Member Name*

First Last

Email*

You will receive an email confirmation at this address.

Enter Email Confirm Email

Select event date & location*

RSVP for both events by submitting two registration forms - one per campus.

Friday, June 24 in Orange County at 6:00pm

Saturday, June 25 in Los Angeles at 5:30pm

Number of Members attending the event*

Guests attending must be named on your membership at the time of visit. You may purchase 4 companion tickets ($10 each) the evening of the event should you wish to invite family and friends. A valid Discovery Cube membership card is required for entry. Dual members are allowed 2 guests.

Number of paid companion tickets

You will be able to pay for companion tickets the night of the event.

Innovator Memberships

Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Phone(Required)

Secondary Name*(Required)

*Secondary card holder must reside at same address

Campus(Required)

Purchase Type(Required)

New Innovator

Renewal Innovator

Membership Level

Comment

Total

Enter Credit Card(Required)

Billing Zip Code(Required)

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Payment Type

Hidden

Source

CAPTCHA

Phone

This field is for validation purposes and should be left unchanged.

Donation Form

Name(Required)

Email(Required)

Address(Required)

In Honor Of (First Name )

In Honor Of (Last Name)

Comment

Donation Amount

Other Amount

Campus(Required)

Discovery Cube OC

Discovery Cube LA

Donation Type

Total

Enter Credit Card(Required)

Card Details

Cardholder Name

Hidden

Payment Type

Hidden

Source

CAPTCHA

Phone

This field is for validation purposes and should be left unchanged.

Donation Form

Name(Required)

Email(Required)

Address(Required)

In Honor Of (First Name )

In Honor Of (Last Name)

Comment

Donation Amount

Other Amount

Campus(Required)

Discovery Cube OC

Discovery Cube LA

Donation Type

Total

Enter Credit Card(Required)

Card Details

Cardholder Name

Hidden

Payment Type

Hidden

Source

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.

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