The MiX Membership Application

Fill out the form below. If you have any questions, please contact The MiX.

Contact Information
Parent Contact Information
Emergency Contact Information
The MiX Media Release
The MiX may use photographs, digital images, video or audio tapes of my child for the purpose of illustration, advertising, trade or publication in any manner on behalf of the Science Museum of Virginia.
14 + 2 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.