SB Requests
This form is for those who wish to request a presentation. No personal data will be exposed except with the express permission of the individuals involved.
Last Name *
Your answer
First Name *
Your answer
Title/Status
Please indicate your title or status relevant to your request: i.e. eighth grade social sciences teacher, Kiwanis program chairman, adult learning instructor, etc.
Your answer
Contact phone *
Please include the number of the phone you would like used to contact you: i.e. (999) 999-9999
Your answer
eMail *
Your answer
Date *
MM
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DD
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YYYY
Title/Status *
Please include your title or status relevant to your request: i.e. Eight grade social sciences teacher, Rotary program chair, 11th grade civics teacher, etc
Your answer
Program Audience *
Please indicate the status or age of the potential audience for planned presentation: i.e. high school civics, college introductory history class, Rotary club general meeting, eighth grade American history class, etc.
Your answer
Proposed presentation date
If known, please indicate the proposed date of the requested presentation.
MM
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DD
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YYYY
Topic keyword *
Please indicate the keyword(s) of the proposed presentation separated by a commas: i.e. American Civil War, marketing, health, Skydiving, etc. If there is more than one word in the key, separate each group of words with a comma: i.e. civil war weapons, the Korean War, How to improve your SAT, etc.
Your answer
Comments/Questions
Please add any comments, clarifications, specific requirements, or questions you might have
Your answer
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