Request a Van Visit

You may submit your Mobile Discovery Center Van Request online by completing the form provided below.  If you need additional information, please feel free to contact our Program Manager by phone or e-mail.

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* Indicates data is required.

Site Contact Information
* Contact Name:
* Title / Position:
* Work Phone: ( )     Ext. 
   Work FAX: ( )       Ext. 
* Home Phone: ( )
* Email Address:  
Showsite Information
* School Name:
* School Address:
* City:
* State:     * ZipCode: 
* Approximate # Students Attending Shows:
(Give specific numbers in "Comments")
* Grades Attending Shows:  

(Programs are designed for 3rd grade and up)

 Please indicate from 1 up to 4 grade levels.
Choice 1:  Choice 2:  Choice 3:  Choice 4: 

Have you had our van visit your site before?  (Yes)  (No)

Additional Comments:

 

  



 
Program Manager Contact Information
Name: Waymon Stewart
One 7th Street
Augusta, GA 30901
Phone: (706) 821-0219 or (800) 325-5445 ext. 0219
FAX: (706) 821-0250
Email: stewartw@nscdiscovery.org