Date of request:
___________________________________
Programme Title:
(e.g. Air Bears; Theory of Flight)
___________________________________________
School
Name:________________________________________
Address:
_____________________________________________
Phone #: ( )
__________________
School
Contact:_______________________________________
Date of
Presentation:__________________________________
Time of Presentation:
__________________________________
# of Children in class & Grade:
______________________
Comments:
______________________________________________________________
______________________________________________________________
______________________________________________________________
