School Name:

School Address:

(2nd line) :

City:

State: Zip:

School Phone:

School Web site:

Contact Person:

Position:

Work Number:

Cell Number:

E-mail:

The date and time you prefer to have the presentation: (please list multiple dates and times just in case there is a conflict with Ji-li's schedule)

1st (Date and time)

2nd (Date and time)

3rd (Date and time)

How many students will be participating?

Comments:

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