BOOK A CODA PROGRAM

Salutation: Mr. Mrs. Ms.

First Name:

Last Name:

School/Organization Name:

Address Line #1:

Address Line #2:

City:

Province:

Postal Code:

Day Telephone:

Evening Telephone:

E-Mail Address:

How did you hear about CODA and our programs?

Which CODA Educator are you requesting?

Which CODA Program are you requesting?

In 100 words or less, give us a brief history of your organization:

Provide a brief project description (100 words max):

What are your goals, objectives and project scope?

How will your project benefit society and the community?

What is innovative about your project?

How many presentations are required? Will these presentations occur in one day or more? If more, how many days?

Date(s) and time(s) of all presentations and the approximate number of attendees:

Full address (incl. postal code) of event location:

Describe any advertising/announcement that you plan to make for this presentation (if using name and logo, CODA will need to approve any advertising material first):

What are your expectations of CODA?