Salutation*
    Mr.
    Mrs.
    Ms.
    Mx.

First Name*

Last Name*

Phone - Cell*

Email Address*

Employer*

The STA provides a half day release for Surrey teachers to provide their workshop. Are you a STA member requesting this time? *
Yes No

Surrey Schools Employees: Courier #, School Name

Salutation
    Mr.
    Mrs.
    Ms.
    Mx.

First Name

Last Name

Phone - Cell

Email Address

Employer

The STA provides a half day release for Surrey teachers to provide their workshop. Are you a STA member requesting this time?
Yes No

Surrey Schools Employees: Courier #, School Name

Workshop title*

Target Audience*
    Elementary
    Secondary
    Elementary and Secondary

Proposed maximum number of people*
    up to 30
    31 - 99
    100 - 299

Is your workshop 90 minutes or 180 minutess in length? *

For a 90 minutes workshop, would you prefer 10:00am - 11:30am or 12:00pm - 1:30pm?

Are you willing to offer the workshop twice on that day (only if you selected 90 minutes for the length)?*
Yes No

Workshop synopsis *

Workshop Proposal