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Youth Outreach: Speaker Request Form
Would you like a speaker to come talk about the Wildlife Center of Silicon Valley, wildlife animals, the rehabilitation process and other related topics? Please fill out and submit this request form to be considered for a speaker. Our Outreach Manager will contact you after receiving your submission.
Group Contact Information
Name, Email, Phone Number, Best time to reach you
Please provide group contact information here: *
Your answer
Group Information
Name, Type of Organization, Age range, Number of expected participants, Address where presentation will occur
Please provide group information here: *
Your answer
Preferred Date *
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DD
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YYYY
Preferred Time *
Time
:
Program Topic Request *
Required
Is there a specific reason for this speaker request? (ex: Teaching unit, student interest, special event) *
Your answer
What do you hope your group gets out of this program (speaker)? Are you interested in activity options or would you prefer an informational presentation? *
Your answer
The animals admitted to WCSV are patients and must have minimal human interaction in order to remain wild and be successfully released. For this reason, we cannot bring live animals to the presentation. We can bring animal artifacts from past patients for educational purposes. We ask that the group leader decide what is appropriate for their program and audience. Please indicate what you would like us to bring below. *
Required
Will we have access to: *
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Any other questions, comments, concerns or requests? *
Your answer
Once you have submitted this request form, our Outreach Manager will contact you.
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