PBS 39 Telebear Visit Request Form

PBS 39 TeleBear Event Request Form
(This form is intended for any person, group or organization who would like to arrange a visit from Telebear.)

Please Note: There is a 2-hour Booking Minimum

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Person Making Request
  
First, Last Name:
Phone:
 , i.e. 610-555-1212
Email:
   
Sponsoring Group or Organization:
Name of Event:
Purpose of Event:
Location of Event:
Anticipated Attendance:
Requested Date:
 , i.e. MM/DD/YY
Requested Start Time:
 , i.e. H:MM AM/PM
Requested Duration:
 , i.e. 2 Hours, 4 Hours, All Day
 
Dates and Times Subject to Availability
Point of Contact First, Last Name:
Phone:
 , i.e. 610-555-1212
Email: