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2. CONTACT INFORMATION
4. Contact Name:
5. Name of Organization/Group/School:
7. Presentation Location
9. City
10. States
    -- Select One --ALAKASAZARCACOCTDEDCFLGAGUHIIDILINIAKSKYLAMEMDMHMAMIFMMNMSMOMTNENVNHNJNMNYNCNDMPOHOKORPWPAPRRISCSDTNTXUTVTVAVIWAWVWIWY
11. Zip Code
13. Daytime Phone Number:*
14. Secondary Phone Number:
16. Email Address:*
20. REQUEST DETAILS
22. Please provide three options for scheduling presentations and allow for at least two weeks lead time.
24. Date and Time of Presentation:*
    Date and Time of Presentation:

    Date and Time of Presentation:
25. Date and Time of Presentation:*
    Date and Time of Presentation:

    Date and Time of Presentation:
26. Date and Time of Presentation:*
    Date and Time of Presentation:

    Date and Time of Presentation:
27. Desired Length of Presentation:*
29. Number in Audience:*
30. Age Range:*
31. Grade Level
    -- Select One --KindergartenElementary SchoolMiddle SchoolHigh SchoolFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeSeventh GradeEight Grade
33. Requested Topics:*

    1. Water Conservation
    2. Drinking Water Quality
    3. Water Treatment
    4. Wastewater Treatment
    5. Careers in Drinking and/or Waster Water
    6. Water Quality
    7. Watersheds
    8. Litter Prevention
    9. Community Greening

    1. Pollinators/Native Plants
    2. Durham Cultural and Heritage Site
    3. Greenways and Trails
    4. Explore Nature
    5. Stargazing
    6. Recycling
    7. Composting
    8. Urban Forestry
35. Please provide any necessary details regarding your request, including the preferred format: In-Person, Zoom, Skype, or Microsoft Teams.
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37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field