In-School Presentation Request

School*
Contact Name*
First Last
Phone*
Region*
School Address*
Address City Province Postal Code
I am interested in having a presentation on one of the following dates:
Please fill in at least 3 dates in the boxes below.
Date 1*
MM slash DD slash YYYY
Date 2*
MM slash DD slash YYYY
Date 3*
MM slash DD slash YYYY
Date 4 (optional)
MM slash DD slash YYYY
Grade Level*
- Intermediate
- Secondary
Number of students
Would you like to receive more than one presentation?*
- Yes
- No
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*

I am interested in having a presentation on one of the following dates: