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2. Name of Organization*
3. Date & Time for Class*
   Date & Time for Class

   Date & Time for Class
5. Age of Attendees*
6. Number of Attendees*
   (No more than 25)
8. Address*
   (Where class is to be held)
9. Apparatus preferred*
11. Materials Wanted to be Covered*
12. Point of Contact*
    (Name/Phone #/Email)
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14. 1. Receive an email copy of this form.
15. Email address

    This field is not part of the form submission.

16. Submit

* indicates a required field