Prevent Blindness Ohio Wise About Eyes: Survey - Bring Exhibits-to-Go to Your School or Classroom

If you would like to bring Exhibits-To-Go to your school, please submit the following information.

1.

Your Contact Information

Name:

Title	First Required	Last Required

*

Email: Required

ZIP / Postal Code:

Yes, I would like to receive e-mail from Prevent Blindness America

Email Format:

Remember me. What's this?

*2.

Question - Required - The name of your school principal

(Maximum response 255 chars, approx. 5 rows of text)

*3.

Question - Required - The name of your school and mailing address

*4.

Question - Required - Grade level(s) for the presentation

(Maximum response 255 chars, approx. 5 rows of text)

*5.

Question - Required - Number of students to be served