BOOK A CODA PROGRAM (french)

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? :

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