Rock Box Order Form

Please fill out the order form below and send a $50.00 refundable deposit to:

Rock Box Order
US Polar Rock Repository
108 Scott Hall
1090 Carmack Rd
Columbus, OH 43210

Your name:
Address:
City:   State:   Zip Code:
Phone number:
E-mail address:
 
Grade Level(s):
# of Students in Class:
School Name:
School District:
School Address:
City:   State:   Zip Code:
Phone number:

Date you would like Rock Box delivered to you:

(Please use the format MM/DD/YYYY)

Please select a method of payment for your $50 deposit (made payable to Ohio State University) Mailing address: USPRR at Byrd Polar Res.Ctr., 108 Scott Hall, 1090 Carmack Road, Columbus, OH 43210:


If you have trouble using this form, please contact the Curator at US Polar Rock Repository.