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Presentation Request Form

Please complete and fax the form to the person and number below.

Suncoast Communities Blood Bank

Attn: Kathy Kendall

(941) 951-2629 Fax

(941)-954-1600 Ext. 1021 Voice

School name:

Date(s) requested for presentation (MM/DD/YEAR)

2^nd Choice:

I am interested in an educational program for all grade levels.

Grade level:

Number of classes:

Number of students per class:

Start / End time for each class:

Address of school:

Directions:

Teacher:

Phone number + Extension:

Fax number:

Best time to call:

Email address:

Sign in at main office:

VCR and TV available:

Comments:

Who may we contact to schedule a blood drive at your school: