REQUEST A VISIT TO YOUR SCHOOL




Contact Name (first and last): * 
Phone: * 
Email: * 
School Name: * 
School Address: * 
LES EDUCATIONAL PROGRAM - Choose One *



Class Information
Grade(s): * 
Room number where presentation will take place: * 
Number of class presentations requested: * 
Number of students in each class: * 
Total number of students: * 
DATE AND TIME PREFERENCES (list three preferences)
First choice (date and time):    MM/DD/YYYY HH:MI AM or PM
 
Second choice (date and time):    MM/DD/YYYY HH:MI AM or PM
*  
Third choice (date and time):    MM/DD/YYYY HH:MI AM or PM
* 

* Required information  

If you experience issues completing the form, please email community@les.com.