Presentation Request Form - Municipality of Colchester

Contact Name:(*)

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Title

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School/Organization(*)

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Phone Number:(*)

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E-mail:(*)

Please enter a valid email address.

Address:

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Requested Date:(*)

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Alternate Date:

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Requested Time:(*)

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Alternate Time:

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Expected number in attendance:(*)

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Age group of those in attendance:(*)

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For youth group an adult is required for every 6-10 youths.

Location (Classroom/Room name) (*)

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Additional Comments:

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(max 500)

Security Check(*)

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