In-School Presentation Request

School*

Region*

Contact Name*

First Last

Contact Email*

Phone*

School Address*

Address City Province Postal Code

Please fill in at least 3 dates in the boxes below.

Date 1*

Date 2*

Date 3*

Date 4 (optional)

Grade Level*

Intermediate

Secondary

Number of students

Would you like to receive more than one presentation?*

Yes

Grade Levels*

Number of Students for each presentation*

Class Descriptions*

The presentation room will have:*

Please select all that apply.

LCD Projector or Smartboard

Computer / Laptop

None of the Above

Other

Please specify other equipment*

Name

This field is for validation purposes and should be left unchanged.