Clean Air Ambassadors Presentation Request Form
Thank you for taking the time to feel out our presentation request form! The Clean Air Ambassador Program is free to all educators and supplements a variety of Science Curriculum Standards. If you have any further question regarding the program, please contact us via email at
caambassadors.apcd@gmail.com
. For immediate questions, comments or concerns, please call (805) 781-5743.
* Required
Name:
*
Your answer
Affiliation
*
(School, before/after school program, club, etc.)
Your answer
Address:
*
Your answer
Email Address:
*
Your answer
Phone Number:
Your answer
Student Grade or Age Range
*
Your answer
Best Time of Day to Reach You:
7am - 10 am
10am - 1pm
1pm - 4pm
4pm - 7pm
Please include any additional information we may need.
Your answer
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