Youth Encouragement & Public Education: outreach activity request
Thank you for contacting the Entomological Society of Manitoba through the Youth Encouragement & Public Education link. Our entomology outreach activities consist of brief oral presentations about insects, entomological specimen boxes, and sometimes alive insects. If you are interested in requesting an activity, please complete the form below. Please note that there may be a waiting list. Our Youth Encouragement and Public Education representative will reach out to you as soon as possible.
Name of the school, organization, or group: *
Address of the school, organization, or group: *
Name of the contact person filling the form:
Phone number of the contact person:
Email of the contact person: *
Has the school, organization, or group previously received or participated in a Youth Encouragement & Public Education activity? *
If you answered YES in the previous question, please specify when:
MM
/
DD
/
YYYY
When do you want the activity to be delivered? *
MM
/
DD
/
YYYY
At what time do you want the activity to be delivered? *
Time
:
Do you have an alternative date to do the activity?
MM
/
DD
/
YYYY
Approximately, how many participants will attend to the activity? *
Age range or grade level of participants: *
Activity location: *
Activity interest: *
If you selected OTHER in the previous questions, please explain which is your specific interest: 
Participants entomology knowledge level: *
Requested activity duration in minutes: *
Type of equipment available for the activity: *
Required
If you selected OTHER in the previous questions, please explain which other equipment  would be available:
Let us know if you have any additional comments:
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms