YOUR CONTACT INFORMATION

Firstname

Lastname

Job Title

E-mail

Phone

Fax

SCHOOL / ORGANIZATION INFORMATION

Name

Address

Phone

Fax

Best times/days to contact you

SCHOOL PRESENTATION

What grade(s) do you teach?

Grades attending presentation

Facilities Available Classroom Gym Common room

WORKPLACE PRESENTATION

How many people attending?

People attending Staff Management Both

Facilities Available Boardroom Office Space Common room

PREFERRED PRESENTATION DATE/TIME

First Choice

Second Choice

Third Choice

Send this application toVancouver Regional OfficeEdmonton Community OfficeWinnipeg Community Office