The Mix Membership Form

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

Contact Info
Parental 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.

Parental Consent

I give permission for my child to become a member of The MiX and to participate in activities associated with The MiX.