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ROCK Event Request


  • Complete this form to request a R.O.C.K. visit to your school/organization. This request is not guarantee of the date you request. The student or faculty ROCK director will contact you to finalize this request.

    First Name: *
    Last Name: *
    School/Organization: *
    Address: *
    City:
    State:
    Zip:
    Email: *
    Phone: *
    Grade level the event is being requested for: *
    Approximate number of student participants: *
    Date of Event - First Choice: *  [None] Select a Date Delete the Date
    Date of Event - Second Choice:   [None] Select a Date Delete the Date
    Date of Event - Third Choice:   [None] Select a Date Delete the Date
    R.O.C.K. Event - First Choice: *  
    R.O.C.K. Event - Second Choice:  
    Special Request - Other (If selected from R.O.C.K. Event above):
    Best time of day, best time of the week, etc.:  
    Comment/Additional Information: