Mercer Free School Activity Proposal Form

This form is to propose a new activity which you are willing to facilitate. Please fill in and submit it or e-mail a separate document with the same information.

This section is for the school to contact you.
Your name:
Your e-mail:

This section is for activity listing. [If you are not decided on certain sections, please leave them blank.]
Activity title:
Activity type: Lecture, Workshop, Group activity, On-line,
  Other:
Activity date/time:
Activity location:
Facilitator name(s):
Registration: (please choose and enter whichever you would like to use)
  Through the school's on-line registration form & the school's phone (recommended)
  Through your own e-mail:
  Through school e-mail: @mfs.insi2.org
 
Your phone: (e.g., if you have a business number)
Other:
Activity web page: (if any, or a link to a relevant image)
Activity description:
Please type the following number 5566 in the box at right: