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First Name

Last Name

Email

Phone Number

Personal Email

*Some school districts have strong firewalls. Please include a personal e-mail as a back up.

Grade Level

Number of Students

Room Number

School Name

School Street Address

City

Province

Postal Code

Tell us how this guest speaker will support your classroom teaching.

Preferred Date(s).

Reminder: Offered mornings only, from start of day until lunch. No exceptions. Please list dates in order of preference.

Special Notes

Please let us know about your school's visitor procedure, parking availability, accessibility, etc.

Morning Bell

Recess Bell

Lunch Bell

How did you hear about MineralsEd?