*Note: Please estimate the numbers as closely
as possible.
*Classes per day:
*Hours of instruction per class:
Number of students per class:
(separate students per class with a comma)
Total number of workbooks requested:
School Requesting Program:
Teacher Name:
School Mailing Address:
City:
State:
Zip:
Recruiter's Name:
Recruiter Mailing Address:
Recruiter Phone Number:
Materials needed:
Workbooks
DVD
Goggles
Pens
Brochures
Other:
How do you want to receive your materials?
