Program Request

Program requested _____________________________________________________________

Date___________________________           Time ____________________________________

Location (& directions) __________________________________________________________

Anticipated number of participants _______________________

Description of audience (approx. age, interests, job assignments, etc. that will help me to tailor the program to their interests and needs)

Equipment available _____________________________________________________________

Contact Information:

Name__________________________________ e-mail ________________________________

Phone numbers __________________Office _____________________wireless 

                                    _____________________ Fax

Address_______________________________________________________________________

Fax to: Leesa Wood Calvi

            County Extension Agent-FCS

            Kuhlman Extension Center

            200 North Brown Road

            Canyon, TX 79015

            Fax: 806-468-5547

            phone: 806-468-5543

            e-mail: l-calvi@tamu.edu (lower case L’s)