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<table width="450" border="0" cellpadding="0" cellspacing="0"> <tr> <td class="font2"> <p class="font2" align="justify">To request a Passages to Canada event at your organization or school, please complete the form below. We make an effort to match appropriate speakers with each group, so please provide as much detail as possible. </p> <br> <form name="submit_passages_event" action="request_event_act.asp" target="_top" method="POST" onsubmit="return validateme(this)"> <input type="hidden" name="Approval" value="0"> <table cellspacing="0" cellpadding="0" border="0" align="center" width="100%"> <tr valign="top"> <td align="right" valign="middle"> <p class="formelement"> <span class="italic">First name:</span> </p> </td> <td align="left" valign="middle"> <p class="formelement"> <input name="FirstName" id="FirstName" type="text" size="20" style="width:150px" /></p> </td> </tr> <tr valign="top"> <td align="right" valign="middle"> <p class="formelement"> <span class="italic">Last name:</span> </p> </td> <td align="left" valign="middle"> <p class="formelement"> <input name="LastName" id="LastName" type="text" size="20" style="width:150px" /></p> </td> </tr> <tr valign="top"> <td align="right" valign="middle"> <p class="formelement"> <span class="formelement">Name of School/Organization:</span> </p> </td> <td align="left" valign="middle"> <p class="formelement"> <input name="Name_School_Organization" type="text" size="20" style="width:150px" /></p> </td> </tr> <tr valign="top"> <td align="right" valign="middle"> <p class="formelement"> <span class="italic">School/Organization Address:</span> </p> </td> <td align="left" valign="middle"> <p class="formelement"> <input name="School" id="School" type="text" size="20" style="width:150px" /> </p> </td> </tr> <tr valign="top"> <td align="right" valign="middle"> <p class="formelement"> <span class="italic">City:</span> </p> </td> <td align="left" valign="middle"> <p class="formelement"> <input name="City" id="City" type="text" size="20" style="width:150px" /> </p> </td> </tr> <tr valign="top"> <td align="right" valign="middle"> <p class="formelement"> <span class="italic">Province:</span> </p> </td> <td align="left" valign="middle"> <p class="formelement"> <input name="Province" id="Province" type="text" size="20" style="width:150px" /> </p> </td> </tr> <tr valign="top"> <td align="right" valign="middle"> <p class="formelement"> <span class="italic">Postal Code:</span> </p> </td> <td align="left" valign="middle"> <p class="formelement"> <input name="PostalCode" id="PostalCode" type="text" size="20" style="width:150px" /> </p> </td> </tr> <tr valign="top"> <td align="right" valign="middle"> <p class="formelement"> <span class="italic">Telephone (where we can reach you during the day):</span> </p> </td> <td align="left" valign="middle"> <p class="formelement"> <input name="Telephone" id="Telephone" type="text" size="20" style="width:150px" /> </p> </td> </tr> <tr valign="top"> <td align="right" valign="middle"> <p class="formelement"> <span class="italic">Email:</span> </p> </td> <td align="left" valign="middle"> <p class="formelement"> <input type="text" name="Email" value="" size="20" style="width:150px"> </p> </td> </tr> <tr valign="top"> <td align="right" valign="middle"> <p class="formelement"> <span class="italic">Course Title:</span> </p> </td> <td align="left" valign="middle"> <p class="formelement"> <input type="text" name="CourseTitle" value="" size="20" style="width:150px"> </p> </td> </tr> <tr valign="top"> <td align="right" valign="middle"> <p class="formelement"> <span class="italic">Grade/Level:</span> </p> </td> <td align="left" valign="middle"> <p class="formelement"> <input type="text" name="GradeLevel" value="" size="20" style="width:150px"> </p> </td> </tr> <tr valign="top"> <td align="right" valign="middle"> <p class="formelement"> <span class="italic">Group Size:</span> </p> </td> <td align="left" valign="middle"> <p class="formelement"> <input type="text" name="GroupSize" value="" size="20" style="width:150px"> </p> </td> </tr> <tr valign="top"> <td colspan="2" align="left" valign="middle"><br> <p class="formelement"> <span class="font2">Please indicate a specific date/time for the event</span> </p> </td> </tr> <tr valign="top"> <td align="left" valign="middle"> <p class="formelement">1)Date: <input type="text" name="VisitDate" value="" size="20" style="width:150px"></p> </td> <td align="left" valign="middle" nowrap> <p class="formelement">Time: <input type="text" name="VisitTime" value="" size="20" style="width:150px"></p> </td> </tr> <tr valign="top"> <td colspan="2" align="left" valign="middle"><br> <p class="formelement"> <span class="italic">Additional information about the group:</span> </p> </td> </tr> <tr> <td colspan="2" align="left" valign="middle"> <p class="formelement"> <TEXTAREA style="WIDTH: 400px" name=informationAboutGroup rows=10 cols=25></TEXTAREA> </p> </td> </tr> <tr valign="top"> <td colspan="2" align="left" valign="middle"><br> <input type="image" name="submit" src="images/main/submit_button.jpg" border="0"><br> <p class="font2">Download the <a href="PTC_edu_guide.pdf">School and Community Group Resource Guide</a> to prepare your group for an event.</p> <br> </td> </tr> </table> </form> </td> <td width="10"> </td> </tr> </table>
Passages to Canada receives funding from Canadian Heritage’s Human Rights Program. Click
here
to read the Press Release.
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