CPRI CLINICAL SERVICES Presentation Booking Information

Please complete one form for each request.

Please note that only one request from each organization/agency will be accepted at this time. 

Question Title

* 2. Name:

Question Title

* 3. Agency:

Question Title

* 5. Address

Question Title

* 6. Phone Number

Question Title

* 7. Email Address

Question Title

* 8. Presentation Date Requested

Question Title

* 9. Location

Question Title

* 10. Estimated Number of Attendees (Minimum of 30 required)

Question Title

* 11. Target Audience (e.g. agency staff, parents, etc.)

Thank you for completing this survey. A CPRI staff will be in contact within 5-7 business days. 

Should you wish to express your appreciation for the worth of this presentation, please do so by making a donation to VOCPRI, Volunteer Organization of CPRI (Registered Charitable Organization License #89249 7249 RPR0001) in lieu of a gift or honourarium. You may do so by contacting VOCPRI at (519) 858-2774 ext. 2074.

Thank you.

T