Re-Entry Mississippi

Name*
First Last
Email
Enter Email Confirm Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Attending Monday’s public program, 8 July 2019” (FREE)*
- Yes
- No
Adult Tickets: $35
Child Tickets: $15

*If you check yes to attend Monday's public program, you will be forwarded to a payment processing page upon completion of this form. Confirm your meal plan purchase by following the link in your confirmation email.
Attending Monday’s Mini-Space Camp*
- Yes
- No
Children ages 5 - 16; guardian MUST attend the public programs in order for your child to participate in the Mini-Space Camp.
Child Information #1
Name
First Last
Age as of July 1, 2019
Legal Guardian
First Last
Guardians Email
Enter Email Confirm Email
Phone
Cellphone
Add a 2nd Child?
- Yes
Child Information #2
Name
First Last
Legal Guardian
First Last
Age as of July 1, 2019
Guardians Email
Enter Email Confirm Email
Phone
Cellphone
Add a 3rd Child?
- Yes
Child Information #3
Name
First Last
Legal Guardian
First Last
Age as of July 1, 2019
Guardians Email
Enter Email Confirm Email
Phone
Cellphone

Child Information #1