OCIC Outreach Program Reservation Form

To assist you with booking an outreach program for your organization, please complete the following information. A member of OCIC will contact to you finalize your reservation.

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* 1. Contact Information

Name

Organization

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

County

Email Address

Phone Number

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* 2. Number of Attendees:

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* 3. Preferred Program Time:

Time

Time

AM/PM

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* 4. 1st Choice Date:

Date

Date

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* 5. 2nd Choice Date:

Date

Date

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* 6. 3rd Choice Date

Date

Date

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* 7. Please choose the outreach program you would like to schedule.